2 insurer battles to know

Payer Issues

In the last two weeks, two lawsuits concerning spine and orthopedic insurers have made headlines.

The Medical Protective Co., which provides malpractice insurance, is trying to back out of paying damages for a spine surgeon who fled the U.S. amid multiple lawsuits. Atiq Durrani, MD, allegedly performed unnecessary spine procedures on hundreds of patients in the U.S. and fled to Pakistan in 2013 after he was charged. One lawsuit related to those procedures resulted in a jury verdict in favor of the patients and nearly $1 million in damages, according to a complaint filed March 1 in the Hamilton County Court of Common Pleas. By fleeing the U.S., Dr. Durrani breached his obligation to cooperate with Medical Protective, the complaint said.

Another lawsuit was filed against Aetna Life Insurance, arguing that the insurer improperly limits coverage for lumbar artificial disc replacement by treating the procedures as experimental and investigational. Plaintiff Andrew Howard suffered from disc disease at L5-S1 that caused significant pain and mobility, and conservative measures such as medication and corrective exercises did not provide adequate relief, according to court documents. Robert Bray Jr., MD, recommended Mr. Howard undergo lumbar ADR, but Aetna denied the request, and the patient had to pay for the procedures out of his own pocket. Aetna is also facing a 239-person class-action suit from 2019 related to its alleged denial of lumbar ADR.

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