Lumbar disc replacement coverage case against Aetna to move forward

Carly Behm -  

A lawsuit over Aetna Life Insurance's spine surgery coverage that was originally dismissed in 2019 will now go forward, according to a motion granted June 11.

Brian Hendricks and Andrew Sagalongos were recommended lumbar artificial disc replacement surgery and are each covered by Aetna, according to the lawsuit. Aetna allegedly denied both of their requests, saying the procedure was "experimental or investigational."

In 2019, District Judge Cormac J. Carney ruled the lawsuit didn't have enough information and that Mr. Hendricks needed to specify the terms that would entitle him to benefits under the Employee Retirement Income Security Act.

Mr. Carney has now allowed Mr. Hendricks and Mr. Sagalongos' class of 239 patients to litigate the allegations. The class is defined as, "All persons covered under Aetna Plans, governed by ERISA, self-funded or fully insured, whose requests for lumbar artificial disc replacement surgery were denied at any time within the applicable statute of limitations, or whose requests for that surgery will be denied in the future, on the ground that lumbar artificial disc replacement surgery is experimental or investigational, and whose denials will be subject to abuse of discretion review by the district court."

Note: Aetna didn't immediately respond to a request Monday morning for comment. This article will be updated if they reach out.


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