If Aetna denied coverage for your single-level lumbar artificial disc replacement (L-ADR) surgery because it considered the procedure experimental or investigational, you may qualify for benefits through a class action settlement.
Depending on your situation, the settlement could provide up to $55,000 in reimbursement, allow you to submit a new request for coverage, or reimburse a future surgery. Here’s what you need to know.
What happened?
The lawsuit claimed Aetna Life Insurance Company improperly denied coverage for single-level lumbar artificial disc replacement (L-ADR) surgeries for members enrolled in ERISA-governed health plans.
According to the lawsuit, Aetna classified the procedure as experimental or investigational, resulting in coverage denials for eligible patients.
Who is eligible?
You may be eligible if all of the following apply:
- You were covered by an ERISA-governed health plan insured or administered by Aetna.
- Aetna denied a precertification request or post-service claim for a single-level lumbar artificial disc replacement (L-ADR) as experimental or investigational.
- Your denial occurred:
- Between Aug. 7, 2016, and Feb. 8, 2023 (Hendricks action), or
- Between March 4, 2019, and Feb. 8, 2023 (Howard action).
- You received a settlement notice.
The settlement may include:
- People who paid out of pocket for the surgery after Aetna denied coverage.
- People who have not yet had the surgery and are still covered by an eligible Aetna ERISA health plan.
- People who have not had the surgery, are no longer covered by Aetna, and do not have other available coverage for the procedure.
How much money can you get?
The settlement offers three different forms of relief, depending on your circumstances.
| Benefit | What You May Receive |
|---|---|
| Past Surgery Reimbursement | Up to $55,000 for documented out-of-pocket costs for a previously denied single-level L-ADR surgery. |
| Future Surgery Coverage (Current Aetna Members) | Eligible members who are still covered by an ERISA-governed Aetna plan can submit a new request for coverage under the settlement terms. |
| Future Surgery Reimbursement (Former Aetna Members) | Up to $55,000 for a future single-level L-ADR surgery if you no longer have an eligible Aetna plan and do not have other available coverage. |
The reimbursement only applies to eligible unreimbursed out-of-pocket medical expenses related to the surgery.
Your options
| Option | What it means |
| Submit a Claim | Apply for reimbursement or request the coverage relief available under the settlement. |
| Exclude Yourself | Keep your right to pursue your own lawsuit, but you will not receive settlement benefits. |
| Object | Tell the Court why you disagree with the settlement while remaining part of the class. |
| Appear at the Hearing | Ask to speak at the Court hearing regarding the settlement. |
How to file a claim?
To receive settlement benefits, eligible class members must submit a claim and any required supporting documentation.
Depending on the type of claim, documentation may include:
- Proof of your single-level L-ADR surgery
- Proof of out-of-pocket payment
- A statement showing your unreimbursed expenses
- A treating surgeon’s attestation or medical necessity letter for future surgery requests
Claims may be submitted online or by mail through the Settlement Administrator.
Important deadlines
- Former member future surgery claims: August 11, 2026
- Past surgery reimbursement claims: September 10, 2026
- Current member coverage request claims: December 9, 2026
Think you may qualify? Review your eligibility and submit your claim before the applicable deadline.
