Aetna to pay $25million to the family of a woman who died of cancer after the insurance company refused to cover her treatment recommended by doctors

[Sugar Cookie]

A jury has ordered Aetna to pay more than $25 million to the family of an Oklahoma woman who died after the insurance company refused to cover a type of radiation therapy.

Jurors found that Aetna doctors didn't spend enough time reviewing Orrana Cunningham's case before denying her coverage for proton beam therapy in 2014, The Oklahoman reported.

The jury ruled that Aetna 'recklessly' disregarded its duty to deal fairly and in good faith with Orrana, who had a rare type of head and neck cancer.

The payment, which was awarded to her estate and her husband, Ron Cunningham, is believed to be among the largest in a single 'bad faith' insurance case.

In 2013, Orrana started experiencing pain in her face, according to a GoFundMe page set up by her husband.

She was first diagnosed with a strained muscle and pulled tendon in her left jaw but, after six months, her pain worsened.

Two of Orrana's lymph nodes then began to swell on the left side of her neck. Her general physician prescribed her antibiotics, but the swelling didn't subside.

In September 2014, she visited an Ear, Nose and Throat doctor who performed CAT scans and a biopsy on one of the lymph nodes.

In November, Orrana received a diagnosis of stage IV nasopharyngeal cancer (NPC) near her brain stem.

This rare cancer occurs when malignant cells form in the tissues of the nasopharynx, which is the upper part of the throat behind the nose

an Aetna doctor denied coverage for the therapy in 2014, deeming it experimental. Two other in-house doctors reviewed and upheld the decision.

The Cunninghams appealed several times but Aetna denied every request.

Doug Terry, the family's attorney 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 couple mortgaged their home in Meeker and started a GoFundMe to help raise money for the $92,000 cost of treatment. They raised nearly $18,000.

Orrana passed away in May 2015 at age 54 after a virus spread to her brain.

https://www.dailymail.co.uk/news/ar...mily-woman-died-cancer-refusing-coverage.html

 

[Knox]

Good. Maybe now they'll realize we PAY for our damn health insurance and we have it so we can USE it. Not so we can be denied and die. I hate insurance companies. But, they are a necessary evil until we can fix our healthcare system.

 

[cubby]

And so over-complicated that it's difficult to understand. I hate insurance too.

Every year during open enrollment , we are inundated with different companies coming around touting the advantages of different companies and it just gets to be too much. And different companies cover different parts of the state, so that limits what you can buy.

Also, I found out that if your disability is based upon a diagnosis of renal failure and you're having dialysis, you can't change insurance, no matter what, no one coud explain that one. I have stage 3 kidney disease, but not in renal failure, so that doesn't apply to me, yet.

 

[Sejanus]

Medical Insurance: It is neither

 

[JackBurton]

There's so many other serious issues with our medical system illustrated in this story.

Why did it take so long to properly diagnose her with cancer? She had jaw/neck pain for 6 months, then her lymph nodes swelled. Still, no scans were done, no proper testing, she was merely given antibiotics. It was only after that didnt work and even more time passed that they finally tested for the cancer.

Those of us who have dealt with serious medical problems, problems that arent readily apparent simpmly by looking at us or throwing some antibiotics our way, know that this isnt some rare occurrence but is far closer to the unfortunate rule of thumb most docs and healthcare providers seem to live by.

I am also curious WHEN in September she had these tests done, and when in November the results came back. Potentially another serious issue if it took nearly 2 full months for test results to come back.

And then we have the outrageous cost of this radiation. 92,000 fucking dollars? I understand that there is good reason for medical procedures to be costly. The technicians/professionals involve need to get paid, the machines used are expensive, and of course if it's a relatively newer treatment or medicine, there are research/development costs that are prob factored in. Even still, 92,000 dollars is absurd. There is no legitimate reason this shit should cost THAT fucking much.

The govt will never address these issues. They will only bitch and moan and try to "solve" problems on the "outcome" side of the shitshow they helped create, and futilely struggle to fund medicare and worry about ACA and whatnot.

I'm curious what Aetnas defense was. Did they fight this claiming the woman still should not have received the treatment, that they werent in the wrong? Did they go super callous and claim she would have died regardless?

 

[OhioRedMermaid]

And so over-complicated that it's difficult to understand. I hate insurance too.

Every year during open enrollment , we are inundated with different companies coming around touting the advantages of different companies and it just gets to be too much. And different companies cover different parts of the state, so that limits what you can buy.

Also, I found out that if your disability is based upon a diagnosis of renal failure and you're having dialysis, you can't change insurance, no matter what, no one coud explain that one. I have stage 3 kidney disease, but not in renal failure, so that doesn't apply to me, yet.

That is shitty and sad about not being able to change insurances...
I am sorry that you are dealing with this disease
[automerge]1542199260[/automerge]

Those of us who have dealt with serious medical problems, problems that arent readily apparent simpmly by looking at us or throwing some antibiotics our way, know that this isnt some rare occurrence but is far closer to the unfortunate rule of thumb most docs and healthcare providers seem to live by.

As someone with an chronic autoimmune issue I fucking AGREE!

 

[cubby]

That is shitty and sad about not being able to change insurances...
I am sorry that you are dealing with this disease

You misunderstand, I'm NOT on dialysis yet. Tho I feel it's useful information I should have known before now.

 

[OhioRedMermaid]

You misunderstand, I'm NOT on dialysis yet. Tho I feel it's useful information I should have known before now.

No, I totally understood that you weren't on it yet based on how you wrote your comment... I still feel bad that you are battling this disease Hugs to you

 

[cubby]

I totally understood that you weren't on it yet

alrighty then I misunderstood, sorry. But thank you, it's not as bad as alot of others have it, but it is an aggravation.