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Aetna因拒绝患癌病人的理赔申请而被要求赔偿2600万美元!

Aetna因拒绝患癌病人的理赔申请而被要求赔偿2600万美元!

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奥克拉荷马州— 陪审团要求医疗保险公司安泰(Aetna)向奥克拉荷马州一家庭支付2550万美元的赔偿,理由是该亲属在其去世前一年间,被Aetna拒绝其放射疗法承保的要求。 奥克拉荷马州报导员说,周一陪审团发现,安泰的医生没有用足够的时间来审查Orrana Cunningham的病例。

OKLAHOMA CITY — A jury has instructed health insurer Aetna to pay an Oklahoma City family $25.5 million for denying a relative's claim for coverage for a type of radiation therapy the year before she died. The jury on Monday found that Aetna doctors didn't spend enough time reviewing Orrana Cunningham's case, The Oklahoman reported.

The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham, who had nasopharyngeal cancer.

Aetna is considering whether to appeal. Company attorney John Shely said the insurer tries to do the right thing.

“If it's in our control to change, that's what we're going to do,” Shely said. “Aetna has learned something here.”

An Aetna doctor denied Cunningham coverage for proton beam therapy in 2014, deeming it experimental, and two other in-house doctors reviewed and upheld the decision.

Doug Terry, the family's attorney, noted that the Food and Drug Administration had approved proton beam therapy, which is also a treatment covered by Medicare. He alleged that Aetna denied coverage for financial reasons and that its doctors were unqualified, overworked and biased when making decisions.

Court records show that one doctor complained to the insurer about having to review more than 80 cases a day.

Cunningham's family had to mortgage their home in Meeker to pay for the therapy in Texas. “We have exhausted all our resources on top of our normal living cost,” her husband Ron Cunningham, wrote on GoFundMe page before his wife died.

Orranna Cunningham, 54, died in May 2015

“My wife, her goal, was to make this fight,” said Ron Cunningham. “Her comment was, 'If we can save one person and stop Aetna from doing what they traditionally do on every claim, it was worth the battle.' ”

According to her obituary, the couple was married 28 years.

Aetna团体医疗保险计划

由上述个案可见,Aetna并不好,所以遭来巨额的赔偿要求。 所以我们不太推荐Aetna的医疗保险计划。

再者,从下图可见,就连Aetna它们自己家的网站上,最新的一份医保价格资料都只是去到2016年,由此可见它们也并不重视团体医保计划的产品,这让我们更加不愿意把它推荐给客人。

Aetna红蓝卡计划

但是,自从Aetna被CVS收购后,就推出了十分吸引人的PPO计划– Aetna的红蓝卡老人计划

以下是我们其中一个参加了Aetna红蓝卡计划的客人的药物申请纪录。

从中可见,此药物申请单中包含好几种不同的药物种类,无需Copay,药物也是不用钱的,那就是全免费!

这就是我们推荐它家的老年人红蓝卡计划的原因!

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