An Oklahoma jury has ordered health insurer Aetna to pay the family of a cancer patient it denied coverage before she died.
According to CBS News, the jury on Monday instructed Aetna to pay the family of Orrana Cunningham $25.5 million for denying her coverage claim for a type of radiation therapy a year before she died.
The jury found that Aetna doctors did not spend enough time to review Cunningham’s case before she was denied coverage for proton beam therapy, a targeted form of radiation that Cunningham’s doctor wanted her to receive to pinpoint her tumor sans the risk of blindness and the other side effects of standard radiation.
The jury ruled that the health insurer recklessly disregarded its duty to deal fairly and in good faith with Cunningham who was diagnosed with nasopharyngeal cancer.
An Aetna doctor who denied Cunningham coverage for the therapy cited that the treatment is experimental. Two other in-house doctors who reviewed the case also upheld the decision.
Doug Terry, the family’s attorney, said that the Food and Drug Administration had approved the therapy, which also happens to be a treatment covered by Medicare.
The lawyer alleged that Aetna denied coverage because of financial reasons and that its doctors were unqualified, overworked and biased when they make decisions.
Court records have shown that one doctor complained to the insurer about having to review more than 80 cases in one day.
Cunningham and her husband Ron decided to mortgage their home when her coverage was denied to pay for the therapy in Texas.
The family also sought financial help through GoFundMe, where they were able to raise $17,790. Ron said that they have exhausted all their resources on top of their normal living cost.
“We are trying in every way to stay positive and come up with the funds for her treatment,” he wrote on GoFundMe.
Despite the family’s efforts, Orrana died in May 2015 at the age of 54.
“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’.”
Aetna reportedly considers whether to appeal. The company’s lawyer, John Shely, said that Aetna 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.”
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