Amputees Sue Blue Shield over its Very Small Network of Prosthetists

Two amputees have sued Blue Shield, a health insurance company, over its failure to maintain a well-developed network of prosthetists, among other allegations. The amputees claim that the company so poorly reimburses prosthetists that it has a very small network of them, which leads to the amputees being forced to pay large amounts out-of-pocket for prosthetic limbs.

Under Blue Shield’s guidelines, their health plans are designed for members to receive services from participating providers, or in-network providers. If members choose to use out-of-network providers, Blue Shield will pay a much smaller portion of the expense. The lawsuit alleges that implicit in the guidelines is a promise that Blue Shield will develop a fully formed network of providers, which will allow customers to receive the primary benefit of the insurance policy.

A recently filed lawsuit claims that Blue Shield has been unable to provide an adequate network of prosthetists because it offers very low reimbursement rates. Therefore, members are forced to seek the services of out-of-network providers, which leaves those members with large bills for their prostheses. The lawsuit is asking that, among other things, Blue Shield be required to reimburse members for their expenses of artificial limbs and to correct its practice of underpaying out-of-network prosthetists.

Several lawsuits are currently underway against insurance companies that have failed to properly provide coverage for prosthetic limbs. If you believe that your insurance company did not properly pay for your limb, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. You may be eligible to join one of the lawsuits. Call today to learn more or to schedule a consultation.