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Insurance Company Pays $25.5 Million for Denying Coverage

Aetna Denies Coverage to Woman Suffering from Cancer

Orrana Cunningham was a homemaker, Rancher, Insurance Agent, Mother, and Wife.

At age 54, Oranna passed away due to the improper treatment of nasopharyngeal cancer, a rare type of throat cancer.
According to the American Cancer Society, fewer than one in every 100,000 people in the U.S. is diagnosed with nasopharyngeal cancer every year.
Although Orrana showed multiple symptoms of the cancer for over 2 years, including sore throats, difficulty opening her mouth, and two lymph nodes on the left side of her neck, she was consistently misdiagnosed and denied coverage for scans, treatment, and medication from Aetna, her insurance provider.
Once a CAT scan was ordered due to the growing lymph nodes, Aetna denied the authorization of these scans. At this time, the doctor filed for an appeal and was eventually approved to move ahead.
A few weeks later, Orranna and Ron got the call.
The diagnosis was Nasal Pharynx cancer. As soon as they received the news, they began consultations with an SW Medical Oncologist and Radiologist. After chemotherapy treatment showed no signs of shrinking the cancer, the doctors advised the couple to travel to Houston, TX to begin an FDA-approved treatment called Intense Modulated Proton Therapy (IMPT).
Once again, Aetna denied the Proton Therapy treatment, deeming it experimental. After losing several appeals, the facility notified Orrana and Ron of the $92,000 cost to continue the therapy.
The Cunningham family then had to mortgage their Oklahoma dream home and move to a small apartment in Houston to continue treatment. Ron started a GoFundMe page in his wife’s name, pleading for help and asking for any donations that their friends and family could contribute. “Our deductibles, coinsurance, and medications so far are over $7,500 and this month will be another $6,000 … I have lost about $7,500 in earning by people working my shifts, and I’ve started to exhaust my vacation and sick time pay”, Ron wrote on the page.
Just four months after their online plea for help, Orrana Cunningham passed away at age 54.

Search for Justice

A lawsuit was filed against Aetna after Orrana’s death and went to court on November 5, 2018, three and a half years later. The attorney argued on multiple aspects of Orrana’s denial of treatment, including the fact that the treatment was FDA approved (should not have been considered experimental) and that the therapy was covered by Medicare.
He claimed that Aetna only denied these requests due to financial reasons and that the doctor who made the denial decision was overworked and biased. Court records even indicated one doctor’s complaint, saying they were tasked with reviewing over 80 cases in a single day.
The jury awarded the Cunningham family $25.5 million after determining that the insurance company “recklessly disregarded its duty to deal fairly and in good faith” with Orrana Cunningham and failed to spend a sufficient amount of time reviewing her case.
Orrana left behind Ron, her husband of 28 years, her son Trevor, whom she called “the highlight of her life”.

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