Aetna Settles Class Action Over Denied Spinal Surgery Claims

What's Happening?

Aetna Life Insurance Co. has reached a classwide settlement to address claims from patients who were denied coverage for spinal surgeries. The settlement allows affected patients to receive up to $55,000 for surgeries that Aetna had previously categorized as experimental and thus not covered. The deal covers at least 381 individuals whose claims were denied, as well as other patients who paid out-of-pocket or plan to undergo the surgery in the future. The total value of the settlement is challenging to quantify, but Aetna has denied over $7.1 million in relevant claims. The motion for preliminary settlement approval is currently before Judge Andre Birotte Jr.

Why It's Important?

This settlement is significant as it addresses the issue of insurance companies categorizing certain medical procedures as experimental, which can lead to denied claims and financial burdens for patients. By agreeing to this settlement, Aetna acknowledges the need to reassess its coverage policies, potentially setting a precedent for other insurers facing similar disputes. The resolution of these claims could impact the healthcare industry by encouraging more transparent and patient-friendly insurance practices, ultimately benefiting patients who require costly medical procedures.

What's Next?

The settlement awaits preliminary approval from the court, which will determine the final terms and distribution of funds to affected patients. If approved, Aetna will begin compensating eligible claimants, potentially influencing other insurers to review their policies on experimental procedures. Stakeholders, including healthcare providers and patient advocacy groups, may push for broader reforms in insurance coverage practices to prevent future disputes.