Aetna lost its bid to decertify a 239-person class-action lawsuit over its coverage of lumbar total disc replacement.
The insurer based its motion to decertify from Wit v. United Behavioral Health, according to court documents filed in the 9th Circuit on July 25. That case reversed certification of a class of health plan patients seeking to "reprocess" their benefit claims, according to Bloomberg Law.
However, Judge Cormac Carney sided with plaintiffs in the disc replacement lawsuit.
"Aetna's denial of coverage for lumbar ADR grounded in company policy communicated in essence that exhaustion of administrative appeals would not yield a different coverage determination, thus rendering exhaustion a vain and useless act and, accordingly, excusing satisfaction of the condition," the order said.
Aetna in December settled the disc replacement class-action litigation and revised its policy in February. Aetna argued that because they revised their policy, "there is no relief the Court could order that would 'perforce affect the entire class at once,'" according to court docs. But Mr. Carney said in the order that "injunctive relief concerning Lumbar ADR coverage is still available," along with "corresponding declaratory relief."