At the end of 2017, two individuals who suffered limb loss sued United Healthcare in California, accusing the company of wrongfully denying claims for microprocessor prostheses. They are seeking to add additional plaintiffs and to certify the case as a class action lawsuit.
The lawsuit claims that United Healthcare has developed and implemented a Coverage Determination Guideline called “Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs”. The Guideline provides that: “If more than one prosthetic device can meet the member’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications of the member’s needs.”
The lawsuit claims that pursuant to the Guideline, United Healthcare has systematically denied claims for prosthetic arms and legs without regard to the individual’s functional needs, and without bothering to assess or determine how the requested prosthetic device meets the minimum specifications of the individual’s needs. According to the lawsuit, as a result of United Healthcare’s policy, thousands of people with limb loss have had their claims for prosthetic arms and legs denied by United Healthcare without proper consideration and review, which is required under federal law.
The lawsuit is ongoing in California. The plaintiffs are seeking additional individuals who have suffered limb loss and who have had their claims for prostheses denied by United Healthcare to join the lawsuit. If you had insurance coverage from United Healthcare, and you believe your claim for a prosthesis was improperly denied, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. I am one of the attorneys involved in the lawsuit and can help ensure your legal rights are protected. Call today to learn more or to schedule a free consultation.