United Healthcare, a health insurance company, has been sued for refusing to pay claims for prosthetic limbs. According to the lawsuit, the company uses its internal policies to avoid paying legitimate claims for certain types of prostheses.
The lawsuit alleges that the company refuses to pay for microprocessor-controlled limbs for its customers. Microprocessor-controlled limbs use computer chips to help operate the limb. According to studies, they are commonly used and offer users many benefits over body-powered limbs.
The lawsuit alleges that United has developed Coverage Determination Guidelines, which are written positions on whether certain medical treatments are covered or excluded under the company’s insurance plans. United has a Coverage Determination Guideline called “Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs”, which 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 for the member’s needs.
The lawsuit alleges that United has used the provision to systematically deny prosthetic arm and leg devices without property assessing or determining the individual’s functional needs and without assessing how the requested device meets the minimum specifications of the individual’s needs.
The lawsuit against United Healthcare is seeking to be certified as a class action and is ongoing. If you or a loved one has had a claim for a prosthesis denied by United Healthcare, call me, Conal Doyle, Los Angeles personal injury attorney. I’m currently working on that lawsuit and others. Call today at 310-385-0567 to schedule a free consultation on your case.