The two plaintiffs — one with breast cancer and one with prostate cancer — received recommendations from their oncologists to use proton beam radiation therapy to treat their cancer without damaging surrounding healthy tissue.
Aetna had denied the treatment multiple times despite the oncologists’ recommendations, according to the lawsuit, filed March 31, 2020. The payer claimed the treatment had not been proven to adequately treat breast cancer or prostate yet.
In the Jan. 27 judgement, the judge ruled that the recommendations were “prudent and reasonable clinical judgments” that warranted coverage under medical necessity.
The court must now certify the suing class and determine the amount of damages owed to plaintiffs.
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