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Class Certified Against United HealthCare for Refusing to Cover Artificial Lumbar Disc Surgery

The United States District Court of the Central District of California has certified a class of plaintiffs in a Gianelli & Morris lawsuit alleging that UnitedHealthcare Insurance Company categorically denies coverage for artificial lumbar disc surgery as “unproven” despite the fact that the surgery is safe and effective. Hill v. UnitedHealthcare Insurance Company, Case No. SA CV 15-0526-DOC. Gianelli & Morris previously won class certification in a similar case against Blue Shield of California, Escalante v. Blue Shield, Case No. 2:14-CV-3021 DDP-PJWx.

In its March 21, 2017 decision, the court in Hill granted class certification of a class of ERISA beneficiaries subject to a de novo standard of review. Plaintiff alleges in this case that UnitedHealthcare refuses to cover artificial lumbar disc surgery regardless of the insured’s need for this surgery. This is so despite the fact that the United States Food and Drug Administration has approved several artificial lumbar disc devices and found them safe and effective for the treatment of degenerative disc disease.

The court determined that determined that ERISA members covered under UnitedHealthcare policies shared a common issue because the company “has stated that its standard practice is to deny lumbar ADR as unproven—meaning that it appears that when lumbar ADR is denied as unproven it is denied under standard policy.” Thus, the court granted class certification and appointed Gianelli & Morris as class counsel.

“Insurers like UnitedHealthcare and Blue Shield have adopted positions on cutting-edge treatments like artificial lumbar disc surgery that are out of date and unsupported scientifically,” said Gianelli & Morris partner Rob Gianelli. “When the FDA and the majority of medical specialists practicing in a field find new treatments to be safe and effective, insurers should not be allowed to block their use.”

Gianelli & Morris has successfully prosecuted a number of class actions against health plans that refused to provide needed treatments. These include: Gallimore v. Kaiser Foundation Health Plan, Inc. (reconstructive surgery benefits); Arce v. Kaiser Foundation Health Plan, Inc. (applied behavioral analysis and speech therapy for autistic children); Bath v. Blue Shield of California (improper rescissions of health policies).

Categories: 1405,1406

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