Two amputees recently filed a lawsuit against Blue Shield of California for failing to authorize payment for some types of prostheses and for underpaying out-of-network prosthetists for their services. The amputees are claiming that Blue Shield’s actions violated the Unfair Competition Law in California. They are seeking other amputees who have suffered financial losses as a result of Blue Shield’s practices to join the lawsuit.
The plaintiffs claim that Blue Shield has a policy of claiming that microprocessor-controlled foot prostheses are investigational, and therefore will not cover them. The health insurance policies issued by Blue Shield do not provide coverage for any health care services or devices the company deems to be investigational. The lawsuit claims that microprocessor technology has been used in prosthetics for decades and is standard in the industry and therefore is not investigational.
The lawsuit also alleges that the company allows its members to obtain services from in-network health care providers, and if a member chooses to work with an out-of-network provider, the member will normally pay a larger amount out-of-pocket for the health care services. The lawsuit alleges that implicit in the contract is the assumption that Blue Shield will develop a fully formed network of providers. However, Blue Shield has a very small network of prosthetists because of its low reimbursement rates, which results in most members being forced to seek the services of out-of-network providers.
The plaintiffs claim that Blue Shield’s policies are a violation of California’s business laws, and that the company should be forced to pay them compensation as well as to change their business practices. If you are an amputee and Blue Shield has not properly paid for your prosthesis, you have legal options. You may be able to join this lawsuit or seek compensation in other ways. Call me, Conal Doyle, Los Angeles personal injury attorney at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation.