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OKLAHOMA CITY (AP) – A jury sentenced Aetna to pay more than $ 25 million to the family of a woman from Oklahoma City who died a year after the insurance company refused to cover a type of radiotherapy.
The jurors found that Aetna's doctors had not spent enough time examining Orrana Cunningham's case before denying him proton beam coverage in 2014, The Oklahoman reported. The jury found that Aetna had inconsiderately misunderstood her obligation to treat Cunningham, who had nasopharyngeal cancer, fairly and in good faith.
Aetna is considering appealing this week's decision. The company's attorney, John Shely, said the insurer was trying to do the right thing.
A jury found that Aetna had recklessly failed in her duty to treat fairly and in good faith with Orrana Cunningham, suffering from nasopharyngeal cancer.
"If we have the control to change, that's what we're going to do," said Shely. "Aetna has learned something here."
A doctor of Aetna refused coverage of therapy by Cunningham in 2014, considering it as experimental. Two other internal doctors reviewed and confirmed the decision.
The Food and Drug Administration has approved proton beam therapy, which is also covered by Medicare, according to Doug Terry, the family's lawyer. He alleged that Aetna had refused coverage for financial reasons and that his doctors were unqualified, overworked and biased in their decisions. The court records show that a doctor complained to the insurer to have to examine more than 80 cases a day.
After being denied coverage, Cunningham and her husband decided to mortgage their home in Meeker, about 56 km east of Oklahoma City, in order to pay for the treatment. Texas. She died in May 2015 at the age of 54.
"My wife, her goal, was to do this fight," said Ron Cunningham. His comment was, "If we can save a person and prevent Aetna from doing what they traditionally do for each claim, the battle was worth it. "
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