Two individuals who lost limbs and were customers of Anthem have sued the company, alleging that the company wrongfully labeled artificial limbs as “investigational” and therefore refused to pay for them. The plaintiffs claim that the limbs are not investigational and that the company should be forced to provide them.
In its insurance policies, Anthem does not cover services that are “investigational”. Anthem defines investigational services as:
- Services that have limited use on humans, which are not generally accepted as proven and effective procedures within the organized medical community;
- Services that do not have final approval from the appropriate governmental regulatory body;
- Services that are not supported by scientific evidence which permits conclusions concerning the effect of the service, drugs, or device on health outcomes;
- Services that do not improve the health outcome of the patient treated;
- Services that are not as beneficial as any established alternative;
- Services whose results outside the investigational setting cannot be demonstrated or duplicated; or
- Services that are not generally approved or used by doctors in the medical community.
Anthem has defined artificial limbs that are controlled by computer devices as investigational. Two customers of Anthem whose limbs were not covered by the company have sued the company and are seeking to turn that lawsuit into a class action.
If you are a customer of Anthem and your claim for an artificial limb has been denied, call me, Conal Doyle, Amputation Lawyer, at 310-385-0567. I am working on several lawsuits against insurance companies and I can help. Call today to learn more or to schedule a free consultation on your case.