Anthem, the health insurance company, was sued last year on the basis of its failure to provide coverage for microprocessor-controlled foot-ankle prostheses. The lawsuit was initiated by two Anthem customers suffering from limb loss whose limbs were denied on the basis that the prostheses were “not medically necessary for all indications.”
One of the Anthem customers who sued the company lost his leg in an accident. At the time of the accident, he had an active lifestyle that included hiking, jogging, and mountain biking. Prosthetists recommended that he receive a below-the-knee device that included a Trans-tibial High-Fidelity Interface prosthesis.
The company denied the claim, stating that the device “may not be the most basic leg” that met his needs. In its denial, the company said that his insurance policy only covers the most basic artificial leg that will meet his needs, and that the leg that was requested was not the most basic. The plaintiff appealed the decision a couple of times, but was denied. The company failed to provide any facts or reasons supporting the denial and instead simply alleged that the requested prosthesis was not the most basic for the plaintiff.
If you have suffered limb loss and your insurance company has refused to provide you with a prosthesis that meets your needs, you should speak with an attorney. Call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am working on several lawsuits against companies which have refused to provide coverage for some prostheses. Call today to learn more or to schedule a free consultation.