Anthem Health Accused of Wrongfully Labeling Prosthetic Limbs as “Investigational”

Anthem, a health insurance company, has been sued by two of its members who are suffering from limb loss. They claim that Anthem failed to properly pay their claims for prosthetic limbs. They are seeking to turn their lawsuit into a class action lawsuit so that others who were similarly affected can join the lawsuit. They are also asking that the company be required to change its policies going forward, and to compensate them for their artificial limbs.

Anthem has labeled certain types of prostheses as “investigational” in some of its claim denials. The limbs they label as investigational are microprocessor-controlled limbs, which are artificial limbs that are controlled by computer chips and sensors, rather than being powered by the human body. According to the lawsuit, microprocessor limbs are now standard in the industry and are routinely prescribed.

Under Anthem’s insurance plans, “investigational” services are not covered. The company defines “investigational” services as services: 1) that have progressed to limited use on humans; or 2) that do not have final approval from the government; or 3) that are not supported by scientific evidence; or 4) that do not improve the health outcome of the patient; or 5) that are not as beneficial as an alternative; or 6) whose results cannot be demonstrated or duplicated; or 6) that are not generally approved or used by doctors in the medical community. The lawsuit alleges that microprocessor devices are not investigational and do not meet any of the criteria in the policies.

If you are an amputee and you have had a claim denied by Anthem, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. My team can help. You may be eligible to join the lawsuit. Call to learn more about your legal rights.