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Aetna & Bad Faith Claims

Aetna provides health insurance coverage to over 250,000 Californians and is one of the nation’s largest health insurance providers. Nevertheless, Aetna has time and again been criticized and penalized for bad faith and denying its customers the care they need and deserve under the terms of their policies. They’ve also been the subject of an investigation after a medical director for Aetna described never reviewing medical records when assessing claim denials.

Failing to provide medically necessary and research-backed care isn’t just cruel; it’s illegal. At the Los Angeles offices of Gianelli & Morris, we’ve spent over 35 years pursuing claims against insurance companies when they have pulled their clients up short. Our seasoned Los Angeles insurance bad faith lawyers can help you get the coverage you need, along with any additional compensation you deserve after a bad faith denial of your health insurance claim.

Aetna receives nationwide attention for verdict after denying proton beam therapy

Proton beam therapy is a powerful and scientifically well-supported treatment method for certain forms of cancer. Aetna is one of the numerous insurers which developed a policy of denying the treatment, telling patients that it is “investigational” or “experimental,” despite years of research and hundreds of medical experts who say otherwise. Aetna is one example of an insurer which has denied coverage of proton beam therapy when doctors believed it was a patient’s best chance at survival, though the carrier may reconsider that policy after a recent verdict.

Orrana Cunningham was an Aetna policyholder who had developed a nasopharyngeal tumor near her brain stem. Her doctors recommended that she receive proton beam therapy. This treatment would provide targeted radiation that reduced the chances of damage to her vision or memory that traditional forms of radiation could cause. Aetna denied coverage of the treatment for Orrana as being “investigational and experimental.” Orrana and her husband attempted to raise enough money to pay for the treatment out of pocket, but they were unable to do so before Orrana passed away from an infection that reached her brain. Her husband pursued a lawsuit against Aetna that Orrana had filed before her death, and an Oklahoma jury agreed that coverage should have been provided based on available evidence. The jury awarded the family $25.5 million based on Aetna’s reckless denial of coverage.

California insurance commissioner investigates Aetna’s coverage decision

Aetna has also been the target of scrutiny by California’s government insurance watchdogs for years. In 2018, the company drew the scrutiny of California’s insurance commission when the testimony of a medical director made the commissioner question the legitimacy of Aetna’s claim approval process. While testifying in a deposition for a case claiming wrongful denial of coverage, the then-medical director for Aetna for Southern California testified that he never reviewed a patient’s medical records when reviewing coverage decisions. Instead, he simply took the word of the nurses who recommended denying or approving a claim. The office of the insurance commissioner immediately launched an investigation into individual claim or pre-authorization denials made while the medical director worked for Aetna, examining whether decisions were made by nurses that should have rightly been made by physicians who took a hard look at the patient’s medical records.

This was not the first investigation launched by California’s insurance commissioner. In 2014, then-insurance commissioner Dave Jones criticized the insurer for raising premiums by as much as 20% in a single year, even when the commissioner’s office concluded that a rate hike of 2.6% would be more appropriate.

Gianelli & Morris Attorneys Have the Skill and Ability to Take on Insurance Giants like Aetna

Insurance customers who have received a bad faith denial of their claims are likely to be severely outgunned if they appeal wrongful claim denials without experienced bad faith insurance attorneys on their side. The bad faith insurance attorneys at Gianelli & Morris have been successfully representing victims of wrongful claim denials for years. Our seasoned litigators have the knowledge, skill and resources to fight these massive corporations so that our clients get the coverage and compensation they deserve.

If you’ve been the victim of a wrongful claim denial in California, choose experienced and aggressive bad faith insurance attorneys to pursue a claim on your behalf by contacting the Los Angeles offices of Gianelli & Morris for a free consultation on your case at 213-489-1600.

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