Blue Shield Settles ERISA Class Action Over Lumbar Disc Surgery

Blue Shield of California settled a class action by health plan participants challenging its exclusion of coverage for artificial disc replacement surgery (Escalante v. Cal. Physicians’ Serv., C.D. Cal., No. 2:14-cv-03021, motion for preliminary approval of settlement 3/10/17).

Blue Shield agreed to revise and implement a medical policy that will no longer exclude coverage for lumbar ADR surgery as “investigational,” according to settlement documents filed March 10 in federal court in California. The insurer also agreed to allow its members whose requests for lumbar ADR surgery were previously denied to seek reimbursement.

If approved, the settlement ...