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Gianelli & Morris wins class certification against Blue Shield over its refusal to cover artificial lumbar disc surgery as “investigational."

Gianelli & Morris wins class certification in case against Blue Shield over its refusal to cover artificial lumbar disc surgery as “investigational.”

Gianelli & Morris has won class certification in a class action lawsuit against Blue Shield of California on behalf of patients who had their requests for artificial lumbar disc surgery denied as “investigational.” Traditionally, surgeons recommended a spinal fusion to treat degenerative lumbar disc disease. Fusion, however, causes a lack of mobility at the fused disc level and, consequently, more stress on the adjacent disc levels leading to a greater risk of additional disc disease. With artificial lumbar disc surgery, the diseased disc is replaced with an artificial disc that maintains the integrity of the disc space while providing the flexibility of a natural disc. This spares the adjacent discs from increased stress while providing the patient with greater mobility.

In 2006, the FDA approved the ProDisc-L lumbar artificial disk device as safe and effective for the treatment of degenerative disc disease. Despite the FDA’s approval, and the widespread performance of artificial lumbar disc surgery with the ProDisc-L device, Blue Shield refuses to cover it in all circumstances saying it is investigational and excluded from coverage.

In granting class certification, the Court agreed with plaintiff, represented by Gianelli & Morris, that the question of whether artificial lumbar disc surgery is investigational presents a common issue that can be resolved on a class basis. This means that a decision in this case will bind Blue Shield on all of its artificial lumbar disc surgery decisions past, present, and future. Escalante v. Blue Shield of California, United States District Court Case No. CV-14 03021 DDP.

Categories: 1405

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