The mother of a 12-year-old boy who was denied coverage for a certain type of prosthesis sued the United Healthcare, the insurance company that denied coverage. The lawsuit is seeking other plaintiffs who have had their requests for prostheses denied by United Healthcare.
The boy suffers from a congenitally-acquired absence of his right forearm and hand. As he grows, he requires both hands to perform everyday functions as an active 12-year-old boy. A prosthetist recommended that he be given a microprocessor-controlled device which simulates a human hand by providing the six fundamental grips of the human hand. United Healthcare denied the request for the device on the basis that the device exceeded the minimum specifications for the boy’s needs.
The boy’s mother appealed to the insurance company, and the denial was upheld on the basis that the prosthesis included many features that exceeded the boy’s basic needs. The boy’s doctor wrote him a new prescription, and the boy’s prosthetists put together a new written order for a cheaper prosthesis. His prosthetists also provided further documentation explaining why a basic prosthesis did not meet the boy’s needs. The new claim was also denied.
The boy’s mother is suing United Healthcare, claiming that the company did not properly assess his needs, and failed to provide any facts or reasons supporting the denial. The lawsuit is seeking to be a class action and is looking for other plaintiffs whose claims for prostheses were denied. If you have had a claim for a prosthetic device denied by your insurance company, call me, Conal Doyle, personal injury attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation.