Family wins $200million health insurance payout after lung cancer-suffering father died after being denied coverage for proton therapy treatment

• Bill Eskew, who died in March 2017 aged 65 after suffering with lung cancer, was diagnosed following a sharp pain in his arm when as he played golf with his son
• His insurers rejected a claim for proton beam therapy recommended by doctor 
• The 65-year-old undertook intensity-modulated radiation therapy which caused serious damage to his esophagus, leaving him to suffer for the last year of his life
• Wife Sally says she told Sierra Health & Life of the therapy before any agreement
• Family won an initial $40million, then another $160million ordered by civil jury

The family of a man who died after being denied health insurance for lung cancer treatment have said they are hoping that their $200million civil verdict win will stop the same thing happening again.

Bill Eskew, who died in March 2017 of lung cancer aged 65, was diagnosed following a sharp pain in his arm when he playing golf with his son, William Eskew Jr., in north west Las Vegas in summer 2015. He believed he had dislocated his elbow his first shot of the day.

After being driven to hospital, doctors revealed the pain was a pathological fracture from lung cancer – but Bill had not been diagnosed with the disease before that point.

Bill Eskew, who died in March 2017 of lung cancer aged 65, was seeking proton beam therapy but was rejected by his insurer, Sierra Health & Life, who have just lost $200million in a lawsuit by his family

To make matters worse the family’s health insurance provider announced it was to stop offering private health insurance, leaving them to find another by 1 January 2016.

In February 2016, Mr Eskew was recommended proton beam therapy by his world-renowned radiation oncologist, but his new insurer, Sierra Health & Life (SHL), denied the request, as part of a hidden medical policy by them which states claimants could not claim proton beam therapy for lung cancer.

Without investigation, SHL rejected the claim under ‘lack of medical necessity’.

This left the then-64-year-old Bill with no choice but to undergo an alternative radiation therapy called intensity-modulated radiation therapy (IMRT), which caused serious damage to his esophagus.

For the next and last year of his life, Mr Eskew, a husband and father-of-two, suffered greatly, with the inability to eat or drink without immense pain or food getting stuck in his throat.

His wife, Sandy Eskew, said she had inquired with Sierra Health about her new insurance policy prior to signing any agreement, adding that the insurer knew she was looking at proton therapy if her husband was a candidate.

Mrs Eskew hired attorneys Matthew L. Sharp and Doug Terry to find out how SHL could have rejected her husband’s cancer treatment coverage, later filing a lawsuit as the widow was not made aware of the proton therapy clause. 

What is the lung cancer side effect, pathological fracture?

Pathological fractures are frequent skeletal-related events among lung cancer patients, and make operative treatment decisions challenging.

It is a break in a bone that is caused by an underlying disease. 

It results in high morbidity and decreased overall survival.

Source: The National Library of Medicine

In 2019, the Eskew family sued SHL and this month won $40million (£30.7million) in Las Vegas District Court.

Another $160million (£122.8million) in punitive damages against Sierra Health & Life was awarded by the civil jury and ordered by District Judge Nadia Krall.

Attorneys Sharp and Terry said that the inability to eat impacted other parts of Mr Eskew’s health and he subsequently became withdrawn, isolated and suffering with complications of esophagitis.

In March 2017, Bill died from the lung cancer and other reasons unrelated to the IMRT treatment.

Matthew L. Sharp said: ‘Through discovery, Doug and I uncovered a systematic claims process where SHL automatically denied claims without consideration of the duty of good faith and fair dealing and with knowledge that insureds would suffer and even die.’

Widower Sandy told Review Journal of the lawsuit win: ‘Maybe this won’t happen to the next person.

‘Maybe they will change the way they do things. They just can’t be doing this. They don’t know more than the doctors. It’s just wrong.’

Health insurance company SHL has plans to appeal, a spokeswoman said.

Sierra Health & Life, which is a UnitedHealthCare company, said they are ‘disappointed’ by the jury’s verdict.

‘The verdict and damages awarded do not reflect the facts of this case or the case of the laws that apply here,’ UnitedHealthcare spokeswoman Gordon Shydlo told Review Journal. 

What are the side effects of cancer treatment IMRT?

Intensity-modulated radiation therapy (IMRT) is an advanced type of radiation therapy which is used to treat cancer and noncancerous tumors.

Advanced technology is used to manipulate photon and proton beams of radiation to conform to the shape of a tumor.

Small photon or proton beams precisely blast a tumor, with varying but controlled intensities.

Some side effects could be hair loss, trouble swallowing, skin irritation, nausea and vomiting. 

Rarer side effects include infertility, secondary cancer, or even hanges to your mouth, kidneys, brain, spinal cord, joints, or other parts of your body. 

Source: Mayo Clinic

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