Two amputees sued Blue Shield, alleging that the company’s policies on payment for prosthetic limbs are in violation of its contractual promises. The amputees are seeking to force Blue Shield to change its policies, as well as to receive compensation for their damages.
One of the amputees underwent a leg amputation in 2009 after a car accident. In 2015, he sought help for the problems he was having with his existing prosthetic limb. Under the terms of his insurance policy with Blue Shield, he was required to use an in-network prosthetist in order for the device to be covered. He searched for an in-network prosthetist who could help him with the limb but was unable to find one.
Ultimately, the man obtained the services of a prosthetist who was not an in-network provider for Blue Shield. The prosthetist recommended a below-the-knee device that Blue Shield approved. However, Blue Shield would only pay 37 percent of the prosthetist’s fee, and the man was forced to pay about $18,000 for the limb.
According to the lawsuit, Blue Shield does not have a fully formed network of prosthetists because of its low reimbursement rates. The lawsuit is seeking to force Blue Shield to change its reimbursement rates in order to be able to offer more in-network providers.
If you are an amputee and you have had problems getting your insurance company to pay for your prosthesis, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation on your case.