Aetna’s Lumbar Disc Replacement Settlement Covers 468 People Denied Coverage as “Experimental” — Reimbursement Claims Closed September 29, but Current Aetna Members Can Still Request the Surgery Until December 28, 2026

As of September 30, 2026, two of the three claim deadlines in the Aetna lumbar disc replacement settlement have passed. The official site lists them: former Aetna members had until August 31, 2026 to file the first form for a future surgery, and people who had already paid for the surgery themselves had until September 29, 2026 to ask for their money back — up to $55,000 each. One deadline remains. Class members who are currently covered by an Aetna-insured or Aetna-administered employer plan, and who have not had the surgery, can ask for it under the settlement’s terms until December 28, 2026. The claim form says it in one line: “If you currently receive health coverage through Aetna: You have until December 28, 2026 to complete and submit this form to Atticus Administration at the address below.”

This is a small, closed group, not a public claims program. The court’s final order counts 468 class members, all identified from Aetna’s records, and the class definition contains a condition most settlements do not: members are people “who are mailed the Notice.” If no notice package reached you, you are probably not in the class; the administrator’s line, 1-800-243-4551, can check. There is also no cash pool split among everyone. What the settlement offers is either approval of the surgery or reimbursement of documented out-of-pocket costs, capped at $55,000 per person.

For people who filed before the earlier deadlines, the clocks now run on the administrator’s side. Reimbursement claims get a decision “within ninety (90) days” of receipt; a claim turned down for thin paperwork gets “sixty (60) days to submit sufficient documentation”; and any unfavorable decision can be taken to reconsideration within 60 days, ending — if class counsel and Aetna’s counsel cannot resolve it — with the judge, whose decision “will be final.” A former member who filed by August 31 and is found eligible then has “180 days from eligibility notice mailing” to submit the future-surgery form.

The case concerns what the settlement’s FAQ calls “Aetna’s alleged practice until February 8, 2023 to deny coverage for single-level L-ADR on the basis that it was experimental or investigational under the terms of ERISA-governed health plans administered or insured by Aetna.” L-ADR stands for lumbar artificial disc replacement — replacing a disc in the lower spine with an artificial one — and the settlement covers surgery at a single level only. Aetna “denies that it did anything wrong” and says it complied with its plans and the law; it settled, the site says, “to avoid the cost, delay and uncertainty of continued litigation.”

There are two classes, one for each lawsuit. Both cover people “covered under Aetna Plans, governed by ERISA, self-funded or fully insured” — employer-sponsored coverage, whether Aetna carried the risk or only administered the plan. Coverage that is not an ERISA plan is outside the class. The Hendricks class covers denials from August 7, 2016 through February 8, 2023; the Howard class covers denials from March 4, 2019 to the same end date. What separates them is the standard of review a court would apply to each denial: “abuse of discretion” for Hendricks, “de novo” for Howard. In ERISA cases that generally depends on whether the plan documents give the insurer discretion to interpret the plan (a deferential review) or not (a fresh look) — that is our explanation; the settlement gives both groups the same relief. A denial could have come before surgery, as a precertification request, or after it, as a post-service claim; both count.

The final order records how the class was reached: the administrator “sent the Notices to 467 of the 468 Class Members in the Class, no later than 34 days after entry of the Preliminary Approval Order, by USPS priority mail,” and one more by first-class mail because Priority Mail would not accept the address. It also records: “No Class Members have requested exclusion from the Class.”

The official site lists three kinds of relief, depending on where you stand.

• You already had the surgery and paid for it yourself. Reimbursement of documented, unreimbursed out-of-pocket costs, capped at $55,000. The claim required an operative report or similar records showing a single-level L-ADR, plus proof of payment such as checks, wire receipts or paid invoices. “Reimbursement will be for actual, unreimbursed costs.” Deadline: September 29, 2026 — passed.
• You have not had the surgery and are still covered by Aetna. A new coverage request, decided under the settlement’s terms. The key is your surgeon: the surgeon signs a certification that the planned single-level L-ADR is medically necessary in the surgeon’s judgment, or writes a letter saying so. Aetna may ask the surgeon for more information. Your plan’s normal cost-sharing still applies: “All other provisions of the Class Member’s current Aetna Plan, including those relating to coinsurance or copayments, will apply.” Deadline: December 28, 2026.
• You have not had the surgery and are no longer with Aetna. Reimbursement of up to $55,000 for a future surgery — but only with no other coverage for single-level L-ADR (another plan, insurer or Medicare) and no “reasonable ability to enroll in individual health coverage that provides coverage for single-level L-ADR,” and only with approval before the operation: “If you get the L-ADR before you’ve been approved though this process, you will not be eligible for reimbursement.” The first form was due August 31, 2026.

Once a future surgery is requested, the administrator answers “within 30 days”, and an authorized surgery has to take place within 180 days. The future-surgery form then describes a choice: reimbursement of documented out-of-pocket costs, or Aetna paying the surgeon directly, “up to a maximum amount of $55,000” either way. How that cap fits with ordinary plan coverage for current members is not spelled out on the site; the administrator is the place to ask.

The lawyers are paid on top, not out of the relief. Judge Birotte awarded $2,556,000 in fees and costs to class counsel Gianelli & Morris and incentive awards of $17,000, $17,000 and $10,000 to the three named plaintiffs; the settlement FAQ says these amounts “will not reduce the relief available to Class Members,” and Aetna “will also separately pay the costs to administer the Settlement.”

The form for current Aetna members is the Aetna Future Surgery Claim Form (Exhibit F), linked on the Claim Form page of ladrsurgerysettlement.com; the court also ordered it mailed with the final-approval notice. It asks for:

1. Your name, address, date of birth and phone, and your Aetna member ID, group or employer name, and group number.
2. The surgeon recommending L-ADR: name, NPI number, phone and fax, and whether the surgeon is in Aetna’s network.
3. A signed authorization letting doctors and hospitals share your medical information with Aetna for the review, and your certification under penalty of perjury.
4. The surgeon’s certification that the surgeon recommended a single-level L-ADR, considers it medically necessary and intends to perform it — signed on the form, or as a separate signed letter of medical necessity that says the same things.

The form says to mail it, with supporting documentation, to Hendricks and Howard v Aetna Life Insurance Co., c/o Atticus Administration, PO Box 64053, Saint Paul, MN 55164. The administrator’s email is LADRSurgerySettlement@atticusadmin.com and its phone line is 1-800-243-4551. Because a surgeon has to sign, the practical deadline is earlier than December 28: the surgeon’s office needs time for its part. Send it in a way you can track and keep copies. A former member found eligible after filing the first form uses this same form, within 180 days of the eligibility notice.

Yes, if it matches the court record. The settlement website, ladrsurgerysettlement.com, states that it was “built and managed by Atticus Administration LLC,” the settlement administrator, and lists the same phone number, PO box and email as the claim forms. Notices went out by USPS Priority Mail within 34 days of the November 13, 2025 preliminary approval, and Judge Birotte’s order of June 12, 2026 directed a second mailing: the administrator was to send the Final Approval Notice “along with the claim forms previously approved by this Court, within 14 days of entry of this Order.” The mailing list came from Aetna’s records, which is why a letter can arrive without you having signed up for anything.

What the real process asks for: your Aetna member details, medical information, a signed authorization to release medical records to Aetna, and a surgeon’s signature. What it does not ask for: money. The class lawyers were appointed by the court, and the FAQ says “You will not be charged for these lawyers”; neither the FAQ nor the forms describe any fee to file. A caller or email asking for payment to release a settlement benefit is not part of this process — check it against the phone number and PO box above.

The two lawsuits were consolidated before Judge André Birotte Jr. in Los Angeles. The settlement agreement was filed on October 8, 2025 and preliminarily approved on November 13, 2025; the deadline to object, opt out or ask to speak was February 17, 2026. The fairness hearing, first set for March 27, 2026 in Courtroom 7B at 350 West First Street, was moved to June 5, 2026, and the judge signed the final order and judgment that day. He found the settlement “fair, reasonable and adequate” and wrote that the court “considered and denied all objections”; the order does not say how many there were. The home page of the settlement site still shows the original March date in its notice text; the Important Dates page has the current schedule.

The release is limited in time. Class members give up claims about L-ADR denials that “occurred before February 8, 2023 only.” It does not cover “Any reimbursement claims or requests for coverage, as described below, that were or are denied by Aetna after February 8, 2023,” so a denial after that date is outside the settlement and goes through the plan’s ordinary appeal route. And the settlement is not an admission: the final order says nothing in it may be used as “an admission or concession by or against Aetna.”

The case belongs to a small family of settlements over treatments an insurer refused to cover as unproven. Anthem’s proton beam therapy settlement for prostate cancer patients, which we covered separately, is another, with its own mail-in claim deadline.