The settlement, announced March 3 in the US District Court for the Eastern District of Pennsylvania, allows 142 patients who were denied coverage between June 2017 and October 2020 to receive individual cash payments of up to $24,000. Each settlement class member who submits a timely and valid claim form will receive a minimum payment of at least $10,000, according to the filing.
The lawsuit accuses Aetna of wrongly declining to cover proton beam therapy as a treatment for certain cancers on the grounds that it’s experimental and investigational. In October 2020, after this lawsuit was filed, Aetna revised its coverage guidelines to expand the list of conditions for which proton beam therapy could be considered an appropriate treatment, according to the filing.
The deal is subject to approval by Judge Cynthia M. Rufe, who hasn’t ruled on Aetna’s motion to dismiss.
Proton beam therapy is a cancer treatment that proponents say is more precise than traditional radiation and thus less likely to damage healthy tissue and organs.
Several insurers have been hit with class suits in recent years over their alleged failure to cover proton beam therapy, including UnitedHealthcare Insurance Co., Humana Insurance Co., Blue Shield of California, and Blue Cross Blue Shield of North Carolina.
The Aetna plan participants are represented by First Law Strategy Group LLC and Richard M. Ochroch & Associates PC. The settlement agreement allows them to seek more than $1.5 million in attorneys’ fees and expenses, to be paid separately from the settlement fund.
Aetna is represented by Groom Law Group, Robins Kaplan LLP, and Elliott Greenleaf PC.
The case is Molloy v. Aetna Life Ins. Co., E.D. Pa., No. 2:19-cv-03902, motion for preliminary settlement approval 3/3/23.
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