Aetna acted in bad faith by denying a patient life-saving cancer treatment that could have saved her life, a jury in the Oklahoma County District Court ruled this week.
The insurer now owes the patient’s family $25.5 million in punitive damages for its "intentional, malicious and life-threatening conduct," according to the Associated Press.
The decedent, Orrana Cunningham, suffered from life-threatening stage 4 nasopharyngeal cancer. Her treating physicians recommended she receive proton beam therapy (PBT) treatment, “the best and only treatment” for her condition, according to a brief filed by the plaintiffs.
Cunningham submitted an urgent claim asking Aetna to cover her PBT. Aetna ignored the claim for two weeks, then denied it for being an “experimental or investigational” treatment, even though, unbeknownst to Cunningham, her policy in fact covered it. Her physicians appealed, but Aetna continued to deny coverage.
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Aetna’s nurses and “medical directors” who presided over the appeals, none of whom specialized in radiation oncology, “were medically unqualified to make a good faith decision,” plaintiffs argued.
Moreover, Aetna pays its “medical directors” bonuses for increasing the company’s profits by denying claims, the brief says.
Aetna ultimately made Cunningham pay $92,082 for the PBT treatment—a bill she and her husband had to mortgage their home to pay.
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Cunningham died in May 2015 at the age of 54.
As The Oklahoman reported on Thursday, counsel for the Cunningham family and jurors wanted to send Aetna a message: You must fix the broken healthcare system.
Doug Terry, attorney for the Cunninghams, said he hopes “the jury's voice is heard beyond the walls of this courtroom and into the boardrooms of insurance companies around the country."
John Shely, an attorney for the insurer, said “Aetna has learned something,” and “if it's in our control to change, that's what we're going to do.”
However, the company said in a statement Wednesday it is “disappointed” with the verdict and may move forward with an appeal.