Anthem Insurance Company Sued for Denying Coverage for Some Prostheses Using Faulty Information

Late last year, some customers of Anthem, a medical insurance company, sued the company for its failure to provide certain types of prosthetic limbs. The company has denied coverage for microprocessor-controlled devices, which are prostheses which are controlled by a computer rather than simply powered by the human body.

Anthem denied coverage for those devices, claiming that they are investigational and not medically necessary for all indications. The documentation issued by the company acknowledges that there are studies which show the benefits provided by microprocessor-controlled foot-ankle prostheses.

The company’s documentation actually cites seven different studies in support of its conclusion that microprocessor devices are experimental and investigational. However, all of those studies concluded that microprocessor-controlled devices provided significant benefits over mechanical devices. None of the studies the company cited supports its conclusion that the devices are “experimental and/or investigational”. However, the company says that further study is needed to establish meaningful benefits of microprocessor devices over mechanical devices.

The plaintiffs are asking that Anthem be required to compensate them for their refusal to cover microprocessor prostheses, as well as cover those devices going forward. If you are a customer of Anthem and the company denied coverage for your prosthetic device, call me, Conal Doyle, personal injury attorney, at 310-385-0567. I am working on this lawsuit as well as others. Call today to learn more or to schedule a free consultation on your case.