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Lawsuits build against Aetna's spine surgery coverage

By Admin | March 10, 2022

Another lawsuit has been 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.

Six details:

1. Aetna uses a clinical policy bulletin — a written directive on coverage positions the insurer considers for certain medical treatments — called "intervertebral disc prostheses" when deciding claims for lumbar ADR.

2. The insurer has "systematically denied all requests" for lumbar ADR as "experimental and investigational" under the policy, according to the lawsuit filed March 4 in the U.S. District Court for the Central District of California.

3. Contrary to Aetna's stance, lumbar ADR was approved by the FDA more than 15 years ago and is considered a safe and effective procedure for lumbar disc disease.

4. 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...(More)

For more info please read, Lawsuits build against Aetna's spine surgery coverage, by Becker's Spine Review

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