Bloomberg Law
Jan. 28, 2022, 4:44 PM

Aetna ‘Wrong’ to Deny Cancer Treatment Coverage, Judge Says

Jacklyn Wille
Jacklyn Wille
Legal Reporter

Cancer patients suing Aetna Life Insurance Co. won part of their lawsuit seeking coverage for their proton beam radiation therapy, when a Florida federal judge found the insurer’s decisions denying coverage were “wrong.”

Judge Kenneth A. Marra’s summary judgment ruling, issued Thursday in the U.S. District Court for the Southern District of Florida, rested on his interpretation of the relevant Aetna health plan’s definition of “medical necessity.” A treatment is deemed medically necessary if it reflects the exercise of “prudent clinical judgment” and meets at least one of five other conditions, including being recommended by a medical provider in accordance ...

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