Two individuals suffering from limb loss have sued the Anthem Insurance Company for its failure to provide prostheses for its customers. Among other allegations contained in the lawsuit is the claim that the company denied claims for all microprocessor-controlled foot ankle prostheses. The company has labeled them as investigational and not medically necessary for all indications.
The lawsuit claims that microprocessor-controlled foot-ankle devices use technology to simulate the movements of a normal foot and ankle. The device responds to constant feedback from sensors to the microprocessor, which changes the downward and upward motion of the foot based on walking speed, incline, decline, and type of terrain. The device then makes adjustments in real time. According to the lawsuit, this type of device helps create stability, decreases stumbles and falls, improves ambulation, and decreases the comfort and pain associated with a prosthesis.
The lawsuit alleges that Anthem has wrongly denied coverage for all requests for microprocessor-controlled foot-ankle prostheses. The company had a written policy that stated that microprocessor-controlled foot ankle prostheses are always considered investigational and not medically necessary. The plaintiffs sued the company, alleging that the devices are commonplace and are not investigational.
The lawsuit against Anthem is seeking to become a class action lawsuit. If you are an amputee and you have had your claim for a prosthesis denied by an insurance company, you should speak with an attorney. Call me, Conal Doyle, California amputation attorney, at 310-385-0567. You may be eligible to join one of the ongoing lawsuits. Call today to learn more or to schedule a free consultation.