Some Aetna members who had lumbar disc replacement coverage denied could be entitled to up to $55,000 after the insurer reached a settlement in a yearslong class-action case, according to court documents filed Oct. 8.
The settlement stems from a 2019 lawsuit that was initially dismissed. Plaintiffs Brian Hendricks and Andrew Sagalongos were reportedly denied coverage of lumbar artificial disc replacement because the insurer called the procedure “experimental or investigational.”
The class-action lawsuit of 239 patients was allowed to move forward in June 2021. A settlement was previously reached, but it came to an impasse in 2023.
The settlement motion filed in the U.S. Central District of California is asking the court to approve reimbursements up to $55,000 for Class members who paid out of pocket for single-level artificial disc replacement. Class members who haven’t had their lumbar disc replacement are entitled to surgery or reimbursement for a future surgery.
Class members who are current Aetna members will be authorized for a future single-level lumbar disc replacement if their surgeon deems it medically necessary, without review by Aetna, the motion said. And class members who aren’t Aetna members anymore are eligible for reimbursement up to the Individual cap for a future lumbar disc replacement if their current health plan doesn’t have coverage.
At least 381 class members had pre-authorization or post-service reimbursement claims denied by Aetna, the motion said.
Aetna declined to comment beyond what was stated in the motion.
