Lawsuit accuses Aetna of systematically denying coverage for cancer treatment

A Florida man filed a class-action lawsuit against Aetna Life Insurance Co., claiming it systematically denied coverage for a cancer treatment called proton beam radiation therapy, according to court documents.

The lawsuit, which has been moved to the District Court for the Middle District of Florida, was filed by Scott Lake. Mr. Lake claims Aetna wrongfully denied coverage for proton beam radiation therapy to treat his prostate cancer. The denial, which deemed the treatment experimental, came despite recommendations from oncologists, he claims. 

While some insurers have begun covering proton beam radiation therapy for certain cancers — for example, Medicare generally covers the treatment — it is not uniform across the commercial insurance industry. In 2019, UnitedHealthcare found itself in court over its denial of coverage to one of its members who also sought the treatment for prostate cancer. 

Aetna's proton beam radiotherapy policy, last reviewed in October 2020, outlines when the insurer considers the treatment medically necessary. In the bulletin, Aetna said it considers proton beam radiotherapy "experimental and investigational" for prostate cancer in adults over age 21 "because its effectiveness for these indications has not been established."

Becker's reached out to Aetna for comment on this lawsuit. This article will be updated as more information becomes available. 

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