Insurer Facing $25 Million Payout Due to Declined Cancer Treatment

An Oklahoma jury awarded $25.5 million to the family of a woman with nasopharyngeal cancer who was denied coverage for proton beam therapy by Aetna. The jurors said Aetna “recklessly disregarded its duty to deal fairly and act in good faith.” Aetna argued that the therapy is investigational and experimental. 

The jury awarded Orrana Cunningham’s husband and estate $15.5 million in actual damages and $10 million in punitive damages. Ms. Cunningham was diagnosed in November 2014 with stage 4 nasopharyngeal squamous carcinoma. Her physicians at MD Anderson Cancer Center in Oklahoma City recommended proton beam therapy for more targeted radiation, avoiding the potential for blindness or other adverse events associated with standard radiation. They said the treatment would give Ms. Cunningham “the best and only chance of survival.” 

(CNN) An Oklahoma jury has awarded $25.5 million to the family of a cancer patient denied coverage by Aetna, with jurors saying that the insurer acted "recklessly" and that the verdict was meant as a message for Aetna to change its ways. https://t.co/77N93Pq732

— ConsumerSafetyWatch (@consumersafetyw) November 13, 2018

After being denied coverage, the couple mortgaged their home and set up a GoFundMe page to raise $92,082.19 for the therapy. Ms. Cunningham died May 30, 2015, in part from a viral infection that reached her brain. 

Insurers need more incentives like this to change their ways.

Jury delivers $25.5 million 'statement' to Aetna to change its ways – CNN https://t.co/tPC1OL5sop

— Andrew Marshall (@drewskiMD) November 12, 2018

The Cunninghams argued that Aetna’s medical directors who made the decision to deny coverage were unqualified because none were radiation oncologists and had never treated a patient with head and neck cancer with radiation therapy. They also argued that the medical directors were overworked and unable to spend enough time reviewing Ms. Cunningham’s case.  

Jury delivers $25.5 million 'statement' to @Aetna to change its ways – Aetna denied $95K #cancertreatment experimental and investigational. @CancerGeek @S4PM @smart_patients #hcsm @wegohealth https://t.co/CHQT0dklJc

— ChiariTracy (@ChiariTracy) November 12, 2018

“I hope [this] results in Aetna reevaluating how they evaluate appeals and requests,” said the jury’s forewoman. 

However, this type of denial for proton beam therapy is not uncommon, and many radiation oncologists express frustration about this. A May 2018 report from the Alliance for Proton Therapy Access found that 63% of oncologists’ initial requests for proton therapy were denied. Patients who are denied coverage wait an average of 6 weeks for a final decision, and 58% were ultimately approved, according to the report. 

A jury awards $289 million to a man who says Roundup caused his cancer, thus opening the door for other lawsuits. 

Nasopharyngeal carcinoma patients and family caregivers both experience sleep disturbance. 

Sources: CNN; Modern Healthcare