A federal court in Florida has approved a $3.4 million class action settlement resolving claims that Aetna improperly denied coverage for proton beam radiation therapy to treat cancer.
The lawsuit was filed in 2020 by a Florida resident whose request for proton beam therapy to treat recurrent breast cancer was denied by Aetna in 2019 after her oncologist had recommended the treatment as more effective than traditional radiation therapy.
The complaint alleged that Aetna systematically denied coverage for proton beam therapy for most cancers in adults over 21, deeming it “experimental and investigational,” despite FDA approval dating back to 1988 and widespread use at major cancer centers. The plaintiffs alleged Aetna violated its fiduciary duties under ERISA by prioritizing cost savings over patient care, noting that proton beam therapy can cost significantly more than conventional radiation in some areas.
The parties reached an agreement in January and the judge approved it on Nov. 18. The settlement covers 71 potential class members from ERISA-governed plans who were denied proton beam therapy between January 2015, and March 2024. Each class member who submitted a valid claim will receive between $12,000 and $48,000 in reimbursement based on their actual costs. Aetna separately paid $1.6 million in attorneys’ fees and other costs.
