You are or were covered under an ERISA‑governed plan issued or administered by UnitedHealthcare, and previously had either a pre‑service authorization request or post‑service claim for liposuction to treat lipedema (“Lipedema Surgery”) denied as “unproven.”

The Court sent you the notice because you have a right to know about a proposed settlement of a class action lawsuit, and about all your options, before the Court decides whether to approve the settlement. The notice explains the lawsuit, the settlement, your legal rights, what benefits may be available to you, who is eligible for them, and how to get them.

The Court in charge of this case is the United States District Court for the Northern District of California, and the case is known as Mary Caldwell v. UnitedHealthcare Insurance Company, et al., Case No. 19‑CV‑02861‑WHA.

The lawsuit concerns whether United Healthcare improperly determined that liposuction to treat lipedema was “unproven” and excluded the procedure from coverage from January 1, 2015, through December 31, 2019.

In a class action lawsuit, one or more people, called the “Class Representatives” (in this case, Mary Caldwell), sue on behalf of other people who allegedly have a similar claim. The people together are a “Class” or “Class Members.” Ms. Caldwell—and all the Class Members like her— are called the Plaintiffs. The companies they sued (in this case, United HealthCare Services, Inc. and UnitedHealthcare Insurance Company [collectively referred to as “UnitedHealthcare” or “United”]) are called the Defendants. One court resolves the issues for all Class Members, except for those who exclude themselves from the Class. The Honorable William Alsup is in charge of this class action.

The Court did not decide in favor of Plaintiff or Defendants. Instead, both sides agreed to a settlement. That way, they avoid the cost and risk of a trial, and Class Members may be entitled to reimbursement. The Class Representatives and the attorneys think the settlement is best for everyone whose claims for liposuction to treat lipedema have been denied as “unproven.”

The Court decided that everyone who fits the following description is a Class Member under this settlement:

All persons covered under ERISA health plans, self‑funded or fully insured, that are administered by United and whose claims for specialized liposuction for treatment of their lipedema were denied as unproven between January 1, 2015 and December 31, 2019.

A damages subclass will be created for members denied solely on the grounds that liposuction is “unproven” for the treatment of lipedema and who paid for the surgery themselves.

If you are still not sure whether you are included, you can ask for free help. You can call 1-866-848-0924 and ask the Settlement Administrator for further information to help you determine whether you are a Class Member.

Class members whose claims for liposuction to treat lipedema were denied as “unproven” between January 1, 2015 and December 31, 2019, and who paid out‑of‑pocket for the surgery may make a claim for reimbursement. Class members who have yet to undergo the surgery, may request that their denied requests for coverage be re-reviewed under the terms of the settlement.

If your request or claim for liposuction to treat lipedema was denied as “unproven” between January 1, 2015, and December 31, 2019, under a plan issued or administered by UnitedHealthcare, and you paid out‑of‑pocket for the liposuction procedure, you can make a claim for reimbursement by submitting the claim form that will be mailed following final approval and by providing the information requested therein.

Class Members shall be reimbursed if they (i) had coverage under their plan at the time their claims for liposuction for treatment of their lipedema were denied as unproven, (ii) provide medical records stating that they had liposuction to treat lipedema, (iii) provide evidence of out‑of‑pocket payment, and (iv) attest that the out‑of‑pocket payment has not been reimbursed from another source for which the Class Member owes no reimbursement obligation.

If you submit a claim for reimbursement that meets these requirements, then United will reimburse you for unreimbursed out‑of‑pocket costs for liposuction for lipedema, subject to a reduction only for the cost‑share you would have paid under your contract with United.

If you want to participate in the settlement, you do not have to do anything now. If the settlement gets final approval, you will be sent a claim form after the final approval, which you will then have to fill out and submit no later than May 20, 2024.

If your request or claim for liposuction to treat lipedema was denied as unproven but you did not have the procedure or pay for the surgery, then you can submit a request for re‑review of your request by submitting the re‑review form that will be mailed following final approval and by providing the information requested therein.

A Class Member will be eligible to receive coverage for previously denied liposuction services upon re‑review if (i) she had coverage under her plan at the time of the original denial, (ii) her surgeon verifies that the request is for medically necessary liposuction to treat lipedema, and (iii) the liposuction for lipedema will be provided in an in‑network or out‑of‑network setting (e.g., a hospital or ancillary facility in the United States) as covered under her plan.

If you are currently a United member, reimbursement on a request for re‑review will be made in accordance with your existing United plan. If you are not a current United member, reimbursement will be made in accordance with your United plan in effect at the time United denied your pre‑service request for liposuction to treat lipedema.

If you want to participate in the settlement, you do not have to do anything now. If the settlement gets final approval, you will be sent a claim form after the final approval, which you will then have to fill out and submit no later than May 20, 2024.

If you contact Class Counsel by April 20, 2024, Class Counsel will assist you with your reimbursement and reprocessing requests.

To the extent additional information is needed to approve the reimbursement and re‑review requests, United Healthcare will advise Class Members in writing of what specific additional information is needed and offer a peer‑to‑peer telephone conference with a medical director within 60 days of receiving a reimbursement or re‑review request.

The Settlement includes a streamlined appeal process.

You may appeal United’s reimbursement and re‑review decisions to a Special Master agreed to by the parties, Ed Oster, Esq. of Judicate West. If a Class Member appeals, Class Counsel and United’s Counsel will meet and confer regarding the decision and attempt to resolve it. If the issue remains unresolved, Class Counsel and United’s Counsel will jointly and concisely present the matter to Mr. Oster, for a final resolution. Neither the Class Member nor the parties may appeal or contest the Special Master’s resolution.

Unless you excluded yourself, if (1) you submit a reimbursement request and (a) receive the full reimbursement amount provided for under this Agreement, or (b) accept a partial reimbursement amount subject to the appeal rights in this Agreement, or (2) submit a re‑review request and are determined to be eligible for Lipedema Surgery under this Settlement Agreement, you will be releasing UnitedHealthcare from the following: Claims for relief alleged in the Complaint and the First Amended Complaint for Denial of Plan Benefits, Declaratory Relief, Breach of Fiduciary Duty, and Equitable Relief, under 29 U.S.C. section 1132(a)(1)(B) and 29 U.S.C. section 1132(a)(3), whether representative, class, or individual in nature, that were asserted against any of the United and its Related Parties, and certified for class treatment by the Court, by reason of or arising out of: United’s denial of any request (whether pre‑service or post‑service) for Lipedema Surgery on the grounds that the procedure is “unproven,” under ERISA‑governed plans, either fully insured or self‑insured.

It also means that all of the Court’s orders will apply to you and legally bind you. Staying in the Class does not prevent you from suing on your own for any denial of requests for liposuction to treat lipedema made in the future.

The deadline to exclude yourself from the settlement was October 20, 2023.

Unless you excluded yourself, if (1) you submit a reimbursement request and (a) receive the full reimbursement amount provided for under this Agreement, or (b) accept a partial reimbursement amount subject to the appeal rights in this Agreement, or (2) submit a re‑review request and are determined to be eligible for Lipedema Surgery under this Settlement Agreement, you give up any right to sue UnitedHealthcare for a previous denial of a request for authorization or claim for reimbursement for liposuction to treat lipedema. If you have a pending lawsuit, speak to your lawyer in that case immediately. You must have excluded yourself from this Class to continue your own lawsuit. The exclusion deadline was October 20, 2023. This lawsuit, however, does not resolve any disputes you may have with UnitedHealthcare over any future denial of coverage for liposuction to treat lipedema.

No. If you excluded yourself, you will not be able to seek coverage through this settlement for expenses incurred for liposuction to treat lipedema. But you may sue, continue to sue, or be part of a different lawsuit against UnitedHealthcare.

Yes. The court appointed the following attorneys as Class Counsel: Robert S. Gianelli and Joshua S. Davis of Gianelli & Morris. You will not be charged for these lawyers. If you want to be represented by your own lawyer, you may hire one at your own expense.

Class Counsel applied to the Court for an award of attorneys’ fees and costs. After reviewing that application, the Court determined the amount of any appropriate award. The fees pay Class Counsel for their fees and expenses in investigating the facts, litigating the case, and negotiating the settlement. UnitedHealthcare will pay the fees and expenses that the Court awarded. These amounts will not reduce the relief available to Class Members. UnitedHealthcare will also separately pay the costs to administer the settlement.

The deadline to object was October 20, 2023.

Objecting is simply telling the Court that you do not like something about the settlement. You can object only if you stay in the Class. Excluding yourself is telling the Court that you don’t want to be part of the Class. If you excluded yourself, you have no basis to object because the case no longer affects you. If you objected but did not exclude yourself, and your objection is overruled in whole or in part, then you will nevertheless be bound by the settlement.

The Court held a fairness hearing on November 30, 2023. The Settlement received final approval on December 22, 2023.

No. Class Counsel answered questions the Court had.

The deadline to request to speak was November 9, 2023.

The Notice summarizes the proposed settlement. For the precise terms of the settlement, please see the settlement agreement available at the Important Documents page, by contacting Class Counsel at Gianelli & Morris, 550 S. Hope Street, Suite 1645, Los Angeles, California, Tel. 213‑489‑1600, by accessing the Court docket in this case, for a fee, through the Court’s Public Access to Court Electronic Records (PACER) system at https://pacer.uscourts.gov, or by visiting the office of the Clerk of the Court for the United States District Court for the Northern District of California, , located at 450 Golden Gate Avenue, San Francisco, CA 94102 between 9:00 a.m. and 4:00 p.m., Monday through Friday, excluding Court holidays.

PLEASE DO NOT TELEPHONE THE COURT OR THE COURT CLERK’S OFFICE TO INQUIRE ABOUT THIS SETTLEMENT OR THE CLAIM PROCESS.