Gianelli & Morris files Class Action Complaint Against Aetna…

Policyholders deserve to have their claims evaluated on an individual basis and to have access to treatment which has been proven as safe and effective to treat their medical condition.

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The California insurance law firm Gianelli & Morris announces that on August 7, 2019, Gianelli & Morris filed a class action complaint in the United States District Court, Central District of California, alleging breach of fiduciary duty and seeking recovery of plan benefits and enforcement and clarification of rights under certain Aetna health insurance policies. The case is BRIAN HENDRICKS; ANDREW SAGALONGOS v. AETNA LIFE INSURANCE COMPANY, case number 2:19-cv-06840.

According to the complaint, Aetna has a policy of systematically denying requests for lumbar artificial disc replacement surgery (L-ADR) to treat degenerative disc disease in the lumbar spine. In its denial letters to plaintiffs Brian Hendricks and Andrew Sagalongos, Aetna referred to its Clinical Policy Bulletin (VPB) 0591: Intervertebral Disc Prostheses. According to this CPB, “clinical studies have not proven that replacing your lumbar discs with artificial spine discs is effective to treat lumbar disc disease or other conditions.”

Plaintiff’s complaint alleges that L-ADR is endorsed by the North American Spine Society and is performed at leading medical centers across the country. The complaint also notes that numerous artificial discs have been approved by the FDA over the past 15 years as safe and effective Class III medical devices. The complaint further points out that other major health insurers, including Anthem, United HealthCare, Humana and Cigna, cover L-ADR.

Robert S. Gianelli, as lead attorney for plaintiffs in the case, cites Aetna’s systematic denial of L-ADR as “a prime example of how insurance companies wrongfully deny claims as being experimental and investigational.” Mr. Gianelli contends, “policyholders deserve to have their claims evaluated on an individual basis and to have access to treatment which has been proven as safe and effective to treat their medical condition.” The complaint includes a demand for Aetna to retract its systematic denial of L-ADR and reprocess all claims that it has previously denied as “experimental and investigational.” The lawsuit further seeks an accounting of profits the company has obtained pursuant to these denials, as well as payment of benefits with interest to policyholders who were denied L-ADR on this basis.

About Gianelli & Morris

Gianelli & Morris is a California insurance law firm that concentrates its practice on cases against insurance companies for the wrongful denials of claims. The firm has succeeded in getting numerous major insurers to change their practices when they engage in a pattern or practice of categorically denying certain medical procedures as “experimental and investigational” despite evidence to the contrary.

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