3 insurers disputing patients in alleged wrongful denials for spine surgery claims

Alan Condon -   Print  |
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From an artificial disc replacement lawsuit revived against a commercial payer to a spine device that was allegedly wrongfully denied coverage, here are three insurers involved in spine-related court cases:

1. A Florida woman is suing Anthem, alleging that the insurer didn't cover a spine device that should have been covered under the Employee Retirement Income Security Act. The woman had a spinal decompression procedure with the Coflex interlaminar stabilization device to treat spondylolisthesis and was later notified by Anthem that her claim for surgery with the device had been denied.

2. A lawsuit over Aetna Life Insurance's spine surgery coverage that was originally dismissed in 2019 will now go forward. The case relates to two patients covered by Aetna who were recommended lumbar artificial disc replacement surgery — Aetna allegedly denied both requests, saying the procedure was "experimental or investigational."

3. A North Carolina woman's health plan was ordered to cover her spine surgery after a district court in April found Central States, Southeast and Southwest Areas Health Plan and Welfare Fund Active Plan failed to provide complete records to the reviewers who recommended coverage denial. 

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