March 14, 2024

Aetna Denied Coverage of Proton Therapy Cancer Treatment for 142 Patients

According to the Centers for Disease Control (CDC), more than 1.7 million individuals are diagnosed with cancer each year, with over 600,000 losing their battle. Understanding this, it’s no surprise that considerable resources are focused on research and new treatments constantly arise.

Proton beam therapy, a relatively new radiation treatment, has proven successful in treating a range of cancers; it is safer and more effective than X-ray or photon-based treatments. Thus, oncologists across the country are relying on it to help their patients.

Unfortunately, insurance companies commonly reject health insurance claims for this treatment, negatively impacting the health of their policyholders. In one instance, Aetna, in particular, denied coverage for 142 patients.

Plaintiffs Claimed Aetna Wrongly Classified Proton Therapy as Experimental and Investigational for Certain Cancers

Insurance companies are required to act in good faith.  This means that they must proactively investigate and fairly evaluate your claim or request for treatment. Unfortunately, this does not always happen. Because these organizations’ primary goal is profitability, they often act in bad faith to delay or even deny claims for necessary treatment, including proton therapy.

Between June 2017 and October 2020, Aetna denied proton beam therapy treatment to many suffering from cancer.  The insurance giant justified their claim denials by arguing that the treatment was experimental and investigational, a theory with which many patients and their physicians disagree. In response, a group of 142 individuals banded together to file a class-action suit against the insurance company.

In Settlement Aetna Acknowledged Proton Therapy Was Right Treatment for Specific Cancers

In March of 2023 Bloomberg Law reported that the insurance company agreed to settle this class-action lawsuit.  They stated that the treatment was, in fact, valid, and even went back to revise coverage guidelines to prevent future issues.

The initial settlement was for up to $3.4 million dollars, providing each of the 142 patients up to $24,000 each, with a minimum payment of $10,000 assuming they submit a valid claim form in compliance with the provided time frame.

Not an Isolated Incident

Insurance issues regarding proton therapy treatment are common; insurance denials happen regularly.  In November of 2018, a jury awarded the estate of Orrana Cunningham and her husband, Ron Cunningham, more than $15 million in damages.

As treatment for her Stage Four nasopharyngeal cancer, Mrs. Cunningham’s physicians prescribed proton therapy; her insurer, Aetna, denied coverage for the treatment three times. Sadly, she passed away.

In response, her estate and her husband filed a lawsuit against Aetna. They were led by Doug Terry, an Oklahoma bad faith insurance lawyer who claimed that those who reviewed and denied her request were overworked, unqualified, and biased.  Mr. Terry stated, “They were biased because Aetna pays profit-based bonuses to people who make claim decisions.”

In the end, Mr. Cunningham was awarded $92,00 to reimburse him for the monies he paid for his wife’s treatment, in addition to $500,000.  A judgment of $15 million was awarded to her estate.  In Oklahoma, courts can award punitive damages as well, when the bad faith actions were particularly reckless.  Mr. Cunningham was awarded an additional $10 million dollars in punitive damages.

Doug Terry Law Knows How to Handle Bad Faith Proton Therapy Denials

While we would hope that continued research, proof, and legal awards would make getting approval for proton therapy treatments easy, it is unlikely that this is the case. In fact, denials continue to this day.

If you have cancer and your insurance company refuses to pay for your proton therapy treatment, they may be acting in bad faith.  Consider engaging a bad faith health insurance lawyer to help you get the treatment you need.

Doug Terry, a proton therapy insurance denial lawyer, has hands-on experience in cases like this and a reputation for success.  He knows how insurance companies are supposed to do business and recognizes when their actions are not in accordance with the law.

Reach out to him today at 405-463-6362 to schedule a free consultation during which he can learn more about your specific situation. Time is of the essence when you have cancer and need treatment.  Doug recognizes your urgency and is available to meet with you immediately.

Attorney Doug Terry

Attorney Doug TerryAfter 25 years practicing in a larger firm, Doug chose to open his own practice in Oklahoma City. He brings his wealth of knowledge and his skills as a litigator to bear for his clients in matters of insurance bad faith, personal injury cases and class actions. He won $200 million and $25 million verdicts for clients in cases in which an insurer denied a health insurance claim. Doug has the distinction of being awarded a Martindale-Hubbell “AV Preeminent” rating from his peers in the legal community. He has also been selected as an Oklahoma Super Lawyer. [Attorney Bio]