Two individuals suffering from lower limb loss have sued Anthem on behalf of themselves and others over Anthem’s policy to deny coverage for microprocessor controlled lower limb prostheses. The plaintiffs are asking the court to provide financial compensation to them for their losses, as well as to order Anthem to cover those limbs going forward.
According to the lawsuit, Anthem has developed and used a coverage guideline called the Anthem Medical Policy on Microprocessor-Controlled Lower Limb Prostheses, Policy No. OR-PR.00003. Anthem uses that policy to deny claims for microprocessor controlled lower limb prostheses. Anthem claims that the microprocessor-controlled limbs are investigational and are not medically necessary.
The lawsuit alleges that microprocessor technology has been used in prostheses for decades and has long been standard in the industry. Microprocessors monitor a person’s gait using sensors, and then adjust resistance to the knee bending and straightening to accommodate the user’s walking speed and terrain. This can enhance stability and security for the user. Microprocessor-controlled devices are routinely prescribed for people who meet certain medical criteria.
Two people who suffered from lower limb loss and who had their claims for microprocessor-controlled limbs denied by Anthem have sued on behalf of themselves and others. If you have had a claim for coverage for a prosthetic device denied by Anthem, call me, Conal Doyle at 310-385-0567. I am one of the attorneys working on the lawsuit, and my firm can help. Call today to learn more or to schedule your free consultation on the case.