Proton Beam Radiotherapy

Jury tells Aetna to pay $25 million to late cancer patient’s family

A jury has ordered Aetna to pay $25.5 million to the family of an Oklahoma City woman who died a year after the insurance company refused to cover a type of radiation therapy.

An Aetna doctor in 2014 denied Orrana Cunningham coverage for proton beam therapy for her stage 4 nasopharyngeal cancer on grounds it was experimental and investigational. Two other in-house doctors reviewed that decision separately and upheld the denial.

After she was denied coverage, Cunningham and her husband decided to mortgage their home in Meeker, about 35 miles east of Oklahoma City, to pay for the therapy in Texas. She died in May 2015 at age 54.

The Food and Drug Administration had approved proton beam therapy, which is also a treatment covered by Medicare, according to Doug Terry, the family’s attorney. He alleged that Aetna denied coverage for financial reasons and that its doctors were unqualified, overworked and biased when making decisions. Court records show that one doctor complained to the insurer about having to review more than 80 cases a day.

The jury on Monday decided Aetna recklessly disregarded its duty to deal fairly and in good faith with Ron and Orrana Cunningham. “We just thought it was a broken system,” juror Fred Forde said Tuesday after the 11-day trial ended in Oklahoma County District Court. “We wanted to send a message to Aetna to fix the system. … You need to do something or you’re just going to keep getting sued.” Some jurors described the Aetna doctors as “rubber stamps,” just doing what Aetna wanted them to do.

“There’s not been a verdict of this size in some time in the state of Oklahoma,” Doug Terry said. “I’m really hoping — hoping — that the jury’s voice is heard beyond the walls of this courtroom and into the boardrooms of insurance companies around the country.”

Aetna is considering whether to appeal the ruling. Company attorney John Shely said the insurer tries to do the right thing. “If it’s in our control to change, that’s what we’re going to do,” Shely said. “Aetna has learned something here.”

“My wife, her goal, was to make this fight,” Ron Cunningham said. “Her comment was, ‘If we can save one person and stop Aetna from doing what they traditionally do on every claim, it was worth the battle.'” The widower also said he hopes the verdict will inspire others to stand up to insurance companies and not be bullied.

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