SAN FRANCISCO (CN) – Blue Cross and Blue Shield refuses to cover noninvasive surgery for metastatic cancerous lung tumors by wrongfully defining the procedure as “investigational” and not “medically necessary,” though the FDA has approved it, a class action claims in Federal Court.
The procedure at issue – radiofrequency ablation therapy – involves burning cancerous lung tumors with a hot needle, in patients for whom invasive surgery or chemotherapy are not feasible options. The therapy involves burning small parts of the tumor while the patient is under conscious sedation. Patients often go home the same day, “usually with no pain or soreness,” the complaint states.
Plaintiffs say the FDA has approved the therapy “for the ablation and coagulation of soft tissue” and it therefore is not “investigational.” They also claim that counter to its misrepresentations, Blue Cross has approved the therapy for tumors small than 7 centimeters in diameter for some patients.
Plaintiffs’ lead counsel is David Wood with Wood & Bender of San Buenaventura.