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In a significant legal showdown, a North Carolina federal judge has thwarted Blue Cross Blue Shield (BCBS) of North Carolina's attempt to dismiss a proposed class action lawsuit. The suit accuses BCBS of unlawfully denying coverage for proton beam therapy to treat prostate cancer.

State Worker Health Plan in the Spotlight

U.S. District Judge Louise W. Flanagan's decision hinged on the inclusion of North Carolina's State Health Plan for Teachers and State Employees as a defendant. The plan, administered by BCBS, was deemed a crucial party in delivering relief to plaintiff Alexander Beko, a participant in the plan.

Sovereign Immunity Challenge

BCBS argued that the state plan, shielded by sovereign immunity, couldn't be brought into the suit, thus necessitating dismissal of the entire case. However, Judge Flanagan rejected this argument, emphasizing the sparing use of dismissal and highlighting Beko's compliance with administrative remedies.

BCBS Can't Escape Therapy Coverage Suit : Call for Amendment

Recognizing the pivotal role of the state plan in the litigation, Judge Flanagan granted plaintiffs Doug Paul and Alexander Beko 14 days to amend their complaint and include the state plan as a named defendant.

Premature Assertion of Good Faith

BCBS's bid to dismiss Beko's claim under the UDTPA, citing good faith adherence to its medical policy, was rebuffed by Judge Flanagan. She deemed BCBS's assertion premature, emphasizing Beko's evidence suggesting the insurer's culpability in his injury.

Class Action Certification Questioned

BCBS also sought to strike Paul and Beko's class-action claims, questioning their ability to meet certification requirements. However, Judge Flanagan deferred judgment on this matter, emphasizing that certification questions would be addressed in subsequent discovery phases.

BCBS Can't Escape Therapy Coverage Suit : Silence Amid Legal Turmoil

As the legal battle intensifies, representatives of the involved parties remained tight-lipped, refraining from immediate comment on Judge Flanagan's ruling.

BCBS Can't Escape Therapy Coverage Suit : Legal Representation

Paul and Beko are backed by legal counsel including Elizabeth K. Green of Green Health Law APC, Timothy J. Rozelle of Kantor & Kantor LLP, and Norris A. Adams II of Essex Richards PA. BCBS is represented by Jennifer K. Van Zant and Claire R. O'Brien of Brooks Pierce McLendon Humphrey & Leonard LLP.