Two customers of Blue Shield, the insurance company, have sued the company. The lawsuit alleges that Blue Shield has a very small network of prosthetists because of its low reimbursement rates. The lawsuit further alleges that many customers of Blue Shield who are suffering from limb loss are forced to pay out of pocket for their prosthetic limbs as a result.
The plaintiffs are two men who are suffering from limb loss. One of the men was a customer of Blue Shield and in 2015 he sought help for problems he was experiencing with his prosthetic limb. He was unable to find an in-network prosthetist who could give him a suitable device. He finally obtained the services of a prosthetist, but the prosthetist was not an in-network provider with Blue Shield. Blue Shield approved a below-the-knee device for the man, but only paid 37 percent of the cost. The amputee was forced to pay $18,000 out-of-pocket for the device.
According to the lawsuit, Blue Shield’s low reimbursement rate resulted from the fact that Blue Shield did not develop a fully formed network of prosthetists. Blue Shield had very low contracted rates, which caused the vast majority of prosthetists to refuse to sign a contract with Blue Shield. The lawsuit alleges that this resulted in the plaintiff being forced to pay a large balance.
If you have been forced to pay out-of-pocket for an artificial limb even though you have insurance, call me, Conal Doyle, Los Angeles amputation attorney at 310-385-0567. I can help. I am currently working on several lawsuits against insurance companies. Call today to learn more or to schedule a free consultation on your case.