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Health insurer Aetna faces $25M verdict in coverage case

The Associated Press and The Oklahoman - November 10, 2018 8:49 am

(Information from: The Oklahoman, http://www.newsok.com)
OKLAHOMA CITY (AP) – A jury has instructed health insurer Aetna to pay an Oklahoma City family $25.5 million for denying a cancer patient’s claim for coverage for proton beam therapy.
The Oklahoman reports that the jury on Monday found that Aetna doctors didn’t spend enough time reviewing Orrana Cunningham’s case. The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham.
An Aetna doctor denied Cunningham coverage for the therapy in 2014 because it was an experimental therapy. Two other in-house doctors reviewed and upheld the decision. Cunningham died in May 2015.
Court records show that one doctor had complained to the insurer about having to review more than 80 cases a day.
Aetna Attorney John Shely says the company tries to do the right thing. Aetna is considering options to appeal.

 

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