Division of Administrative Hearings, Florida
Filed: Jan. 14, 2020
Whether Petitioner’s request for coverage of proton beam radiation therapy (“proton beam therapy” or “PBRT”) is a covered benefit pursuant to the State Employees’ Health Maintenance Organization (“HMO”) Plan (“Plan”), administered by AvMed.Petitioner failed to prove proton beam therapy, an experimental and/or investigational treatment, was “medically necessary” when IMRT, an equally effective treatment, was available and approved by Respondent.
