Late last year, two amputees sued the Anthem insurance company in California, alleging that the company wrongfully failed to provide proper artificial limbs for them. The amputees asked that the company be required to pay for certain prosthetic limbs going forward, and that the company reimburse them for their prostheses.
According to the lawsuit, Anthem insurance plans exclude “investigational” services. The company defines “investigational” services as services: (1) that have progressed to limited use on humans, which are not generally accepted as proven and effective procedures within the organized medical community; or (2) that do not have final approval from the appropriate governmental regulatory body; or (3) that are not supported by scientific evidence which permits conclusions concerning the effect of the service, drugs or device on health outcomes; or (4) that do not improve the health outcome of the patient treated; or (5) that are not as beneficial as any established alternative; or (6) whose results outside the investigational setting cannot be demonstrated or duplicated; or (7) that are not generally approved or used by physicians in the medical community.
The lawsuit claims that Anthem wrongfully denied requests for microprocessor-controlled knee prostheses based on those criteria. Microprocessor-controlled prostheses use computer chips to operate a prosthetic limb. The lawsuit alleges that the limbs are not investigational and have been in use for decades.
The plaintiffs are seeking to certify the lawsuit as a class action. If you have had your claim for a prosthetic limb denied, you should speak with an attorney. Call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am currently working on several lawsuits against insurance companies on behalf of amputees, and I am happy to speak with you. Call today to learn more or to schedule a free consultation.