Elevance Health Inc. has agreed to pay $3.3 million to settle a lawsuit accusing it of wrongfully denying coverage for a critical spinal surgery under employee health plans, according to a recent Kentucky federal court filing.
The lawsuit, brought under the Employee Retirement Income Security Act (ERISA), alleged that Elevance—formerly known as Anthem—improperly classified minimally invasive sacroiliac joint fusion surgery as “medically unnecessary,” forcing patients to pay out of pocket for the procedure. The settlement aims to compensate affected plan members while preventing further litigation.
Settlement Seeks Court Approval
The plaintiffs filed a motion Monday requesting preliminary approval of the Elevance $3.3M deal, arguing that the agreement is both fair and reasonable under federal law.
The agreement covers individuals who were denied coverage for the spinal procedure between Sept. 20, 2017, and July 30, 2021, and had to pay for the surgery themselves. Elevance, a major player in the health insurance industry serving over 100 million members, rebranded from Anthem in 2022.
