A man is suing Aetna Life Insurance in the U.S. District Court for the Central District of California, alleging that its denials of lumbar artificial disc replacement surgery violate the Employee Retirement Income Security Act, according to court documents obtained by Becker's.
Andrew Howard, the plaintiff, is covered by a fully insured Aetna plan through his employer, Shamrock Capital Advisors. He has an employee welfare benefit plan that covers medical, surgical and other services.
Mr. Howard alleges that Aetna has repeatedly violated ERISA by denying services for lumbar artificial disc replacement surgery by determining them "experimental and investigational," and therefore excluded from coverage, according to the court documents. Mr. Howard is seeking class-action status for the lawsuit.
The procedure has been approved by the FDA for over 15 years, according to the court documents.
Mr. Howard requested in the lawsuit a reprocess and payment of the health benefits to all class members, a clarification of rights to future benefits under the plan, relief for all class members, a surcharge, payment of all costs and attorney fees incurred by pursuing the lawsuit, payment of prejudgment and post-judgment interest, and other relief the court decides necessary.