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Copyright (c) 2004 Law Review Association of the Quinnipiac University School of Law
Quinnipiac Law Review

ARTICLE: Insurance Roulette: The Experimental Treatment Exclusion & Desperate Patients


Quinnipiac Law Review

22 Quinnipiac L. Rev. 697


By Natalie L. Regoli*


I. Introduction
During the last decade, the archetypal experimental treatment 1 lawsuit has been one in which a gravely-ill patient petitions the court for an order directing his or her insurance company to authorize certain procedures. Such a case begins after standard medical treatment has failed, and the patient's treating physician recommends newer treatments out of the belief that they are the best opportunity to sustain the patient's health and life. In the patient's desperate efforts to procure whatever treatments may improve her condition, the patient decides to assume the risk of these new treatments. 2 The physician requests that the patient's insurance company pre-authorize the treatments, or that the patient individually pays for the treatments. The insurance company refuses to pre-authorize the treatments and replies that the procedures constitute experimental treatments excluded from coverage. Unable to otherwise fund the treatments, the patient sues. 3

Less common cases involve patients who have already received treatments deemed "experimental" by their insurance companies, either by directly paying for the procedures, 4 through community donations, 5 or by the generosity of the treating physicians. 6 In one case, despite the denial of pre-authorization by the insurance company, the patient underwent High Dose Chemotherapy with Peripheral Stem Cell Support ("HDCT/PSCR") treatment as an in-patient at a hospital. 7 The patient did not have to sign a special informed consent document before she began the HDCT/PSCR, nor was the HDCT/PSCR performed as part of any study or protocol. 8 At the ...
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