The Aetna proton beam therapy settlement is a $3.4 million class action resolution, granted final approval on November 18, 2025 by Judge Kenneth A. Marra in the U.S. District Court for the Southern District of Florida, that pays 71 prostate cancer patients between $12,000 and $48,000 each for Aetna’s denials of proton beam radiation therapy under ERISA-governed employer health plans.1Bloomberg Law. Aetna Finalizes $3.4 Million Cancer Coverage Class Settlement2Becker’s Payer Issues. Judge Approves Aetna’s $3.4M Settlement Over Proton Beam Therapy Coverage The case is Sharon Prolow and Mark Lemmerman v. Aetna Life Insurance Company, No. 9:20-CV-80545.3AetnaPBTSettlement.com. Aetna PBT Settlement
Who Qualifies
The class is narrow. To be included, you must have been a member, participant, or beneficiary of an ERISA-governed employee welfare benefit plan that Aetna administered or insured, and the therapy at issue must have been for localized prostate cancer.3AetnaPBTSettlement.com. Aetna PBT Settlement
Between January 1, 2015 and March 31, 2024, one of two things must also have happened: Aetna denied all precertification requests and all post-service benefit claims for proton beam therapy, or Aetna initially approved precertification but then denied all post-service claims for the actual treatment.3AetnaPBTSettlement.com. Aetna PBT Settlement Seventy-one patients fit that description.1Bloomberg Law. Aetna Finalizes $3.4 Million Cancer Coverage Class Settlement
Class members did not have to prove that proton beam therapy was medically necessary for their cancer to receive a payment; the settlement bypassed that question.4Bloomberg Tax. Aetna Signs Cancer Coverage Pact Worth More Than $3.4 Million
What Class Members Receive
The total settlement fund is $3.423 million, of which $3.408 million is designated for class member reimbursements.3AetnaPBTSettlement.com. Aetna PBT Settlement Individual payments run from $12,000 to $48,000, tied to each person’s actual out-of-pocket costs for the denied therapy.2Becker’s Payer Issues. Judge Approves Aetna’s $3.4M Settlement Over Proton Beam Therapy Coverage
Aetna separately agreed to pay $1.6 million in attorneys’ fees and other costs, so legal expenses did not come out of the patient reimbursement pool.4Bloomberg Tax. Aetna Signs Cancer Coverage Pact Worth More Than $3.4 Million Atticus Administration LLC handled the claims process.3AetnaPBTSettlement.com. Aetna PBT Settlement
Key Dates
- Filed in 2020 in the Southern District of Florida.2Becker’s Payer Issues. Judge Approves Aetna’s $3.4M Settlement Over Proton Beam Therapy Coverage
- Settlement agreement reached in January 2025.2Becker’s Payer Issues. Judge Approves Aetna’s $3.4M Settlement Over Proton Beam Therapy Coverage
- Preliminary approval on June 10, 2025.3AetnaPBTSettlement.com. Aetna PBT Settlement
- Claim, opt-out, and objection deadlines on October 3, 2025.3AetnaPBTSettlement.com. Aetna PBT Settlement
- Final approval on November 18, 2025.1Bloomberg Law. Aetna Finalizes $3.4 Million Cancer Coverage Class Settlement
The claim and opt-out window closed on October 3, 2025.3AetnaPBTSettlement.com. Aetna PBT Settlement
What Aetna Was Accused Of
The plaintiffs alleged that Aetna violated its fiduciary duties under the Employee Retirement Income Security Act by systematically denying coverage for proton beam radiation therapy for localized prostate cancer.2Becker’s Payer Issues. Judge Approves Aetna’s $3.4M Settlement Over Proton Beam Therapy Coverage According to the complaint, Aetna prioritized cost savings over patient care by classifying the treatment as “experimental and investigational,” even though the FDA approved proton therapy in 1988 and major cancer centers use it routinely.5Law360. Aetna Gets OK for $3.4M Deal in Cancer Treatment Denial Suit
Aetna’s clinical policy bulletin on proton therapy (CPB No. 0270) treats proton beam radiotherapy and intensity-modulated radiation therapy as “clinically equivalent” for localized prostate cancer, with coverage tied to the terms of each member’s benefit plan.6Aetna. Clinical Policy Bulletin Number 0270 – Proton Beam, Neutron Beam, and Carbon Ion Radiotherapy The suit alleged that in practice, Aetna denied both precertification requests and post-service claims, leaving patients with costs that could reach tens of thousands of dollars.3AetnaPBTSettlement.com. Aetna PBT Settlement In October 2020, after the lawsuit was filed, Aetna revised its coverage guidelines to expand the list of conditions for which proton beam therapy could be considered appropriate.7Proton-Therapy.org. Aetna Patients Score $3.4 Million Proton Beam Therapy Settlement
Not the Same as the Molloy Case
A separate class action, Molloy v. Aetna Life Insurance Co. (No. 2:19-cv-03902), was filed in the Eastern District of Pennsylvania and is distinct from this settlement. Molloy covers 142 patients denied proton therapy coverage between June 2017 and October 2020, with a preliminary approval motion filed in March 2023 before Judge Cynthia M. Rufe. Payouts in Molloy ran from $10,000 to $24,000, and attorneys were permitted to seek more than $1.5 million in fees.8Bloomberg Law. Aetna Patients Score $3.4 Million Proton Beam Therapy Settlement The two cases involve different classes, different courts, and different payout structures, though both concern Aetna’s classification of proton therapy as experimental.