Anthem, a health insurance company, was recently sued by two of its customers who have lost a limb. In their lawsuit, the customers claim that the company is wrongfully denying all requests for certain types of foot-ankle prostheses. The plaintiffs are seeking to make the lawsuit a class action suit so that others who have been similarly affected by Anthem can join the lawsuit.
The lawsuit claims that the company uses its own policies to deny coverage for all requests for microprocessor-controlled foot-ankle prostheses. Microprocessor-controlled prostheses have sensors, a microprocessor, software, and a battery. The other types of prostheses are body-controlled and have been proven to be less effective and more painful for the user than microprocessor-controlled prostheses, which can react in real-time to changes in the environment.
According to the lawsuit, microprocessor-controlled prostheses have been established and accepted by the medical community as “standard” prostheses. Anthem has written policies which exclude microprocessor-controlled prostheses. One policy states that “The use of a microprocessor controlled foot-ankle prosthesis (for example, Proprio Foot of the PowerFoot Biom) is considered investigational and not medically necessary for all indications.”
The customers are suing Anthem, seeking to force the company to change its policies to cover microprocessor-controlled prostheses. If you are or were a customer of Anthem, and the company refused to cover a prosthetic limb for you, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am currently working on three lawsuits against insurance companies and I will be happy to provide you with a free consultation. Call today to learn more.