Aetna Lumbar Artificial Disc Replacement Settlement

Who Is Eligible?

You may be eligible to file a claim if you:

• The class is members of ERISA-governed health plans insured or administered by Aetna who were denied coverage for single-level lumbar artificial disc replacement on the ground that it was experimental or investigational.
• Either kind of denial counts. A precertification request refused before surgery and a post-service claim refused afterwards both put you in.
• Single-level is the limit. The settlement is about one disc. Two-level and multi-level procedures are not what this covers.
• The window depends on which case you fall under. The Hendricks action runs from 7 August 2016, the Howard action from 4 March 2019, and both end on 8 February 2023.
• Aetna identified the class from its own records, which is why members were mailed a notice with a claimant ID on it. If you believe you qualify and nothing arrived, the administrator is the place to sort that out rather than assuming you are out.
• Three groups get three different remedies. People who already paid out of pocket seek reimbursement. Current Aetna members can ask for a future operation to be approved under the settlement's terms instead of the usual coverage rules. Former members who still need the surgery can have a future operation reimbursed, but only if they have no other coverage for it and no reasonable way to buy any.
• One trap deserves its own line. A former member who goes ahead and has the surgery before the settlement approves it gets nothing. Approval first, operation second.

How Much Can You Get?

Reimbursement is capped at $55,000 per person for single-level L-ADR you have already paid for. What you actually receive is your net out-of-pocket cost up to that ceiling, so the cap matters only if your bill ran past it.

Net is the operative word. You claim what you were left paying after any other reimbursement, not the sticker price of the operation.

There is no fund and no pro-rata reduction. Aetna pays claims as they are approved, which means the number of people who file has no effect on what you get. The $2.56 million that appeared on this page as a settlement fund is the attorneys' fee and expense request, and Aetna pays that separately from anything paid to class members.

Current members get coverage rather than cash. If your surgeon attests that a single-level L-ADR is medically necessary, Aetna determines the request under the settlement instead of its usual experimental-or-investigational position. Your ordinary plan terms still apply on top, so deductibles, copays and coinsurance are unaffected.

Former members can get a future operation reimbursed up to the same $55,000, subject to the no-other-coverage test.

Decisions come within ninety days. The administrator reviews what you send and tells you the outcome, and a claim refused for thin documentation gets a further sixty days to be fixed rather than simply dying.

How to File Your Claim

You will need the Claim ID and PIN printed on the notice the administrator sent you. This settlement is not open to anyone who simply believes they qualify.

• Work out which of the three forms is yours before anything else, because they close on different days. Reimbursement if you already paid. Aetna Member Future Surgery if you are still covered. Former Aetna Member Future Surgery if you are not.
• Check the date against that choice. Former members lost their window on 31 August 2026. Reimbursement closes 29 September 2026. Current members have until 28 December 2026.
• Find your claimant ID. It was printed on the notice Aetna's records triggered, and the online form asks for it. If no notice reached you, contact Atticus Administration rather than giving up, because the class was drawn from company records and gaps happen.
• All three forms are on the settlement website at ladrsurgerysettlement.com, each viewable and downloadable as a PDF.
• For reimbursement, gather four things. Proof the surgery happened at a single level, which means an operative report, clinical records or payment records detailed enough to show it. Proof you actually paid, in the form of checks, wire receipts or invoices showing payment. A statement of the exact unreimbursed amount you want back. And the signed form itself.
• For either future-surgery route, the surgeon does the heavy lifting. They must attest that a single-level L-ADR is medically necessary for you, either by signing the relevant part of the form or by writing a separate letter, and Aetna may come back to them for more.
• Former members have one extra attestation to make: that no other plan, insurer or Medicare will cover the operation and that you cannot reasonably buy individual cover that would.
• Do not book the surgery first. A former member who has the operation before approval comes through is not eligible for anything.

Frequently Asked Questions