Aetna has reached an agreement to settle two class-action lawsuits alleging that subsidiary CVS Health violated federal law by wrongfully refusing to cover spinal surgeries for more than 230 patients, according to orders filed in federal court this week.
The patients filing the lawsuit allege that Aetna failed to fulfill its fiduciary obligations under the Pension Security Income Act of 1974 by systematically withholding coverage for an artificial lumbar disc replacement surgery it allegedly misclassified as experimental and research. Documents filed Monday and Tuesday in the U.S. District Court for the Central District of California say Aetna has agreed to settle the cases and that the parties will agree terms by February 17.
Etna and attorneys representing the plaintiffs did not immediately respond to interview requests.
UnitedHealthcare, Elevance Health (formerly known as Anthem), and Blue Shield of California settled similar cases in the same court. In 2004, the Food and Drug Administration approved lumbar spine replacement surgery with an artificial disc as a “safe and effective” treatment for spinal conditions.
Patient Andrew Howard sued Aetna in March, alleging that the insurance company improperly denied his requests for a procedure recommended by his doctor. Howard’s claims echo those of Brian Hendricks and Andrew Sagalongos, patients who sued Aetna in the same court in 2019. Hendrix and Howard underwent the procedure and paid out of pocket, while Sagalongos continues to live with degenerative spinal disease.
Aetna offered to close the Hendrix and Sagalongos case, arguing that insurers had not taken the proper steps to appeal her denials and that the insurance company never promised to pay for the operation at all. Judge Cormac Carney dismissed this argument in 2019, writing in his opinion that patients are not required by law to exhaust their appeals and that, even if they did, they “would be doomed to failure.” Carney certified a class of 239 patients covered by employer plans administered by Aetna. Aetna has not formally responded to Howard’s lawsuit.
In each case, patients asked Aetna to reconsider their claims and the claims of other affected individuals and to end their policy of refusing lumbar disc replacement surgery.