Aetna members who paid out of pocket for lumbar artificial disc replacement surgery may qualify to claim reimbursement of up to $55,000 from the Aetna L-ADR coverage class action settlement, which also requires Aetna to reconsider previously denied requests. Claims are due 90 days after final approval, and the Claimant ID from the notice plus operative records are required.
What Is This Settlement About?
Aetna Life Insurance Company has agreed to resolve a long-running class action over its refusal to cover single-level lumbar artificial disc replacement (L-ADR) surgery — a procedure used to treat degenerative disc disease in the lower spine. The plaintiffs allege that Aetna denied coverage requests for the surgery by classifying it as "experimental and investigational" under ERISA-governed health plans, even though, they claim, the procedure is an established treatment. The case is captioned Hendricks v. Aetna Life Insurance Company in the U.S. District Court for the Central District of California, with a related action, Howard v. Aetna Life Insurance Company, in the same court.Aetna denies any wrongdoing and the settlement resolves the claims without any admission of liability. Under the agreement, eligible members may seek reimbursement for out-of-pocket spending on the surgery, Aetna will reconsider previously denied requests, and Aetna has agreed to pay for covered single-level L-ADR going forward for class members who submit the required proof. Like other health-insurer coverage disputes — such as the Anthem grandfathered Rx settlement and the Anthem residential mental health treatment settlement — this case turns on benefits that members say were wrongly denied under ERISA-governed plans.
Who Qualifies?
The settlement covers people who were covered under an Aetna health plan governed by ERISA — whether self-funded or fully insured — and whose request (pre-service authorization or post-service claim) for single-level lumbar artificial disc replacement surgery was denied on the ground that the procedure is experimental or investigational. The case consolidates two related actions, and the settlement defines the class through two notices that differ by date range and the standard of review the court would apply:- Hendricks notice: denials from August 7, 2016 through February 8, 2023 (denials subject to an abuse-of-discretion standard of review).
- Howard notice: denials from March 4, 2019 through February 8, 2023 (denials subject to a de novo standard of review).
Class members are identified from Aetna's records of denied L-ADR requests and are mailed a class notice with a Claimant ID. If you believe you fall within the class but are unsure, you can confirm your status and the filing requirements through the official settlement website.
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How Much Can You Get?
The settlement provides several forms of relief:- Reimbursement: Class members who already paid out of pocket for single-level L-ADR surgery may seek reimbursement of up to $55,000 upon submitting the required proof.
- Future coverage: For new requests for coverage of single-level L-ADR, Aetna will pay the class member's medical provider directly for the covered services within 90 days of receiving the required proof — or reimburse the class member if they pay the provider directly.
- Reconsideration: Aetna has agreed to reconsider qualifying denied requests under the terms of the settlement.
Because this is a reimbursement-and-coverage settlement rather than a flat per-person cash payment, the amount any individual receives depends on what they actually paid out of pocket and the proof they submit. Review the benefit details and exact filing instructions on the official settlement website before you file.
How to File a Claim
Relief is provided through a Claim Form. To file, you use the Claimant ID printed on your mailed notice and follow the instructions on the official settlement website, LADR Surgery Settlement.com. For reimbursement of a past surgery, you submit documentation showing you had single-level L-ADR (such as an operative report or clinical records), proof of payment (checks, receipts, or invoices reflecting actual payment), and a statement of the unreimbursed out-of-pocket amount you are claiming. For a future surgery, the Claim Form includes a surgeon attestation of medical necessity.The settlement's relief and claim deadlines are tied to Final Approval: reimbursement claims must be submitted within 90 days of Final Approval, and the Court held the Final Approval Hearing on March 27, 2026. The exact filing deadline is stated on the Claim Form mailed to class members after approval — confirm the current deadline on the official settlement website before you file.
Frequently Asked Questions
Who is included in the Aetna L-ADR coverage settlement?
People enrolled in an ERISA-governed Aetna health plan (self-funded or fully insured) whose request or claim for single-level lumbar artificial disc replacement surgery was denied as experimental or investigational between August 7, 2016 and February 8, 2023.
How much can class members receive?
Class members who paid out of pocket for single-level L-ADR surgery may seek reimbursement of up to $55,000. The settlement also provides for reconsideration of denied requests and direct payment to providers for future covered requests within 90 days of receiving the required proof.
Do I need proof to file a claim?
Yes. You file using the Claimant ID from your mailed notice, and for a reimbursement claim you must submit records showing you had single-level L-ADR (such as an operative report) and proof of payment. Check the requirements on the official settlement website before filing.
What is the deadline to file a claim?
Reimbursement claims must be submitted within 90 days of Final Approval; the Court held the Final Approval Hearing on March 27, 2026. The exact deadline is printed on the Claim Form mailed to class members — confirm it on the official settlement website before filing.
Sources
- Official settlement website — LADR Surgery Settlement.com
- Hendricks v. Aetna Life Insurance Company, No. 2:19-cv-06840-AB (C.D. Cal.) — CourtListener docket
