Aetna has reached an agreement to settle two class-action lawsuits alleging its subsidiary CVS Health violated federal law by improperly refusing to cover spine surgery for more than 230 patients, pursuant to an order filed in federal court this week.
The patients filed the lawsuit all lumbar artificial disc, which it allegedly misclassified as experimental and investigative. Records filed Monday and Tuesday in the United States District Court for the Central District of California say Aetna has agreed to settle the cases and the parties will agree on terms by February 17.
Aetna and attorneys representing the plaintiffs did not immediately respond to requests for interviews.
UnitedHealthcare, Elevance Health (formerly known as Anthem) and Blue Shield of California have settled similar cases in the same court. The Food and Drug Administration approved lumbar artificial disc replacement surgery as a “safe and effective” treatment for spinal disease in 2004.
Patient Andrew Howard sued Aetna in March, alleging the insurance company improperly denied his request for a procedure his doctor had recommended. Howard’s statement echoes Brian Hendricks and Andrew Sagalongos, patients who sued Aetna in the same court in 2019. Hendricks and Howard went through the procedure and paid out of pocket, while Sagalongos continued to live with the degenerative disease. spine fusion.
Aetna dismissed the Hendricks and Sagalongos cases, arguing that the policyholders had not followed the appropriate steps to appeal their denials and that the insurer had never promised to pay for the case. this surgery in the first place. Judge Cormac Carney rejected this argument in 2019, writing in his view that patients were not obligated to appeal strongly and that even if they did, they “would have to fail”. Carney certified a class of 239 patients covered by employer plans administered by Aetna. Aetna never officially responded to Howard’s lawsuit.
The patient in each case asked Aetna to re-process their request and that of other affected people and end its policy of refusing lumbar disc replacement surgery.
