Majority: Surgery Not Covered Under Plan, Falls Under ‘Investigational’ Exclusion

Mealey's (June 26, 2018, 10:39 AM EDT) -- PORTLAND, Ore. — A majority of the Ninth Circuit U.S. Court of Appeals on June 22 found that artificial disc replacement surgery fell under the "investigational" exclusion of an Employee Retirement Income Security Act medical benefits plan, affirming a lower court’s ruling in favor of the plan's sponsor, administrator, insurer and claims administrator (Carla Sammons v. Regence BlueCross BlueShield of Oregon, et al., No. 16-35288, 9th Cir., 2018 U.S. App. LEXIS 17005)....

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