A consolidated class action lawsuit has been pending in the U.S. District Court for the Central District of California for about six years. It challenged Aetna Life Insurance Company’s longstanding policy of classifying single-level lumbar artificial disc replacement (L-ADR) surgery as “experimental and investigational,” leading to systematic denials of coverage for plan members seeking this treatment for degenerative disc disease or related spinal conditions.
The consolidated action, In re Aetna Lumbar Artificial Disc Replacement Coverage Litigation, stems from two primary complaints:
– – Hendricks v. Aetna Life Insurance Co. (filed August 2019) Case No.2:19-cv-6840-AB (MAAx): A proposed class action by plaintiffs Brian Hendricks and Andrew Sagalongos, alleging systematic ERISA violations for denying L-ADR coverage to 239 class members from 2014 onward. This case was certified in June 2021 for claims under the “abuse of discretion” review standard.
– – Howard v. Aetna Life Insurance Co. (filed March 2022) Case No. 2:22-CV-01505-AB (MAAx): A separate proposed class action by plaintiff Andrew Howard, alleging similar ERISA breaches for denials under the “de novo” review standard (affecting 43 class members from 2019–2023). Certified in February 2024.
Artificial disc replacement (ADR) is newer type of spinal disc procedure that utilizes an anterior (front – through the abdominal region) approach to replace a painful, arthritic, worn-out intervertebral disc of the lumbar spine with a metal and plastic prosthesis (artificial disc). It is an alternative to traditional spinal fusion.
The suit alleged violations of the Employee Retirement Income Security Act (ERISA), claiming Aetna’s denials were arbitrary, not based on credible evidence, and inconsistent with FDA approvals (e.g., for devices like the ProDisc-L since 2006) and medical guidelines from organizations like the North American Spine Society (NASS). Plaintiffs argued this practice caused financial harm, forcing patients to pay out-of-pocket or forgo treatment.
At At the time of settlement, Aetna had produced nearly 30,000 pages of information concerning the class and merits issues in the consolidated cases. For their part, Plaintiffs produced nearly 1,500 pages of information supportive of their position that Aetna’s policies and practices are amenable to class treatment and that L-ADR is a safe and effective treatment for degenerative disc disease.
The parties participated in multiple days of mediation before Edwin Oster, Esq., an experienced and well-respected private mediator with Judicate West over a three-year period. The parties first participated in mediations and negotiations between July 2022 and April 2023. After these negotiations failed, the parties engaged in further vigorous litigation, merits discovery and expert discovery before participating in an additional mediation and arm’s-length negotiations between March 2025 and May 2025. The parties notified the Court that they reached a settlement in principle on May 16, 2025, two weeks before the final pre-trial conference and six weeks before trial. (
According to the Motion for Preliminary Approval of Class Action Settlement filed on October 8, 2025 by plaintiff attorneys, “After nearly six years of vigorous litigation, investigation, and discovery, multiple mediations, and only six weeks before the scheduled trial in this matter, Plaintiffs Brian Hendricks, Andrew Sagalongos, and Andrew Howard (collectively, “Plaintiffs” or “Class Representatives”) and Defendant Aetna Life Insurance Company (“Aetna”) agreed to settle this class action on the terms set forth in the Settlement Agreement “
The Settlement provides that all Class Members who paid out-of-pocket for Single-Level L-ADR will be reimbursed up to $55,000. In addition, the Settlement provides that Class Members who have not yet the L-ADR are entitled to surgery or reimbursement for a future surgery. Class Members who are current Aetna members will be authorized for a future Single-Level L-ADR so long as their surgeon attests that the surgery is medically necessary for them, without any review by Aetna using Aetna’s own internal medically necessity criteria.
Several other major insurance companies have faced class action or ERISA-based lawsuits challenging their systematic denials of coverage for single-level lumbar artificial disc replacement (L-ADR) surgery, often labeling it as “experimental,” “investigational,” or “unproven” despite FDA approvals dating back to 2004 (e.g., for devices like the ProDisc-L). These cases mirror the Aetna litigation in alleging violations of the Employee Retirement Income Security Act (ERISA) for arbitrary denials that force patients to pay out-of-pocket or opt for less effective alternatives like spinal fusion.
As in the Aetna case, most suits have been filed in the U.S. District Court for the Central District of California, with some settlements achieved. However, coverage has improved industry-wide – now about 90% of private insurers cover single-level L-ADR, up from near-zero in the early 2000s.
Aetna revised its policy in February 2023 to cover single-level L-ADR as medically necessary under certain criteria. These suits have driven policy changes. For instance, post-settlement, UnitedHealthcare and Anthem now cover L-ADR for eligible patients, reducing denials to <10% industry-wide.
Litigation continues in a case pending in the Central District of California which was filed in 2021 against Blue Shield of California. (Torres v. California Physicians’ Service d/b/a Blue Shield of California Case No. 2:21-cv-08942-FMO-JEM filed October 29, 2021).
This suit, led by the same firm (Gianelli & Morris), alleges similar ERISA violations for BSC’s continued blanket denials of L-ADR coverage as “experimental/investigational” post-2017 settlement, particularly for patients not fitting narrow post-policy criteria or under self-funded plans. It claims BSC failed to fully implement the injunctive relief from Escalante v. California Physicians’ Service d/b/a Blue Shield of California (Case No. 2:14-cv-03021-DDP-PJW), leading to renewed harms (e.g., out-of-pocket costs exceeding $40,000 per patient).