Elevance Health settled a class-action lawsuit over denial of coverage for minimally invasive sacroiliac joint fusion surgery, according to an agreement filed March 17 in the U.S. Eastern District of Kentucky.
The settlement includes more than $2.5 million for out-of-pocket payments made for denied spine surgeries and attorney’s fees up to $825,000. Each eligible member of the class can claim up to $15,000.
The settlement applies to patients who were denied coverage for minimally invasive sacroiliac joint fusion between Sept. 20, 2017, and July 30, 2021.
The settlement stems from a 2019 lawsuit that alleged Elevance and its affiliates improperly denied coverage for the procedure, labeling it as investigational and not medically necessary, according to a legal declaration. The lawsuit claimed the denials violated the Employee Retirement Income Security Act.
A spokesperson for Elevance didn’t immediately respond to a request for comment from Becker’s.
