Compensation for Affected Patients
Under the settlement terms, eligible individuals can file reimbursement claims for up to $15,000. However, the agreement caps Elevance’s payout at $2.5 million for settlement claims. Court documents estimate that approximately 1,000 plan members could be part of the class.
Beyond the direct settlement fund, Elevance has also agreed to cover up to $825,000 in attorneys’ fees and litigation costs. Additionally, the four named plaintiffs will each receive $17,500 as part of the deal.
Allegations of Wrongful Denials
The lawsuit, originally filed in September 2019, accused Elevance of violating federal benefits law by wrongfully rejecting claims for the spinal procedure. Plaintiffs contended that the insurer intentionally misclassified the surgery as “investigational” and “not medically necessary” to avoid covering it.
In response, plaintiffs sought a court mandate requiring Elevance to review denied claims and adopt a policy permitting coverage when specific medical criteria were met. By July 2021, Elevance had updated its policy to allow coverage for the procedure.
