Can HMO evade 10123.195 by not prescribing?

[t00h00]

What is the name of your state? California

Can an HMO evade the "off-label drug" law 10123.195 (see [url]http://law.onecle.com/california/insurance/10123.195.html[/url] section a.3.D and a.2.B) simply by not prescribing medically superior treatment?

The law says that an insurance company must pay for off-label treatment if "two articles from major peer reviewed medical journals . . . present data supporting the proposed off-label use".

But the law was written with the idea that the "contracting licensed health care professional" who prescribes is separate from the insurance company.

In my case I have life-threatening cancer; I have identified an off-label drug for which there are dozens of favorable articles in major peer reviewed journals, and which is clearly superior to anything my HMO (Kaiser) is offering (which are also off-label and experimental, but they're in-house and therefore cheaper for Kaiser).

But Kaiser physicians don't want to prescribe treatment that Kaiser doesn't want to pay for -- so I can't get a "contracting licensed health care professional" to prescribe the off-label drug -- so the law leaves me out in the cold? The law is meaningless for HMO members?

What about the "bad faith" law? I read (at [url]http://www.aegis.com/pubs/atn/1994/ATN19205.html[/url], I think) that the insurance company must "attempt to find a basis to pay your claim rather than find reasons to deny it".

Thanks for your help.What is the name of your state?