Late last year, the Anthem insurance company was sued for failing to pay for microprocessor-controlled foot-ankle prostheses for its customers suffering from limb loss. Microprocessor-controlled prostheses use technology to simulate the movements of a normal foot and ankle. The device responds to constant feedback from sensors to the microprocessor and makes adjustments in real time.
Microprocessor-controlled lower limbs are commonly accepted by the medical community at large as “standard” prostheses. They are routinely prescribed for people meeting the appropriate medical criteria. Anthem has developed medical policies that tells whether certain medical treatments are medically necessary and/or investigational. Anthem’s policies are used to deny requests for microprocessor-controlled lower limb prostheses.
Anthem claims that microprocessor-controlled lower limb prostheses are investigational and not medically necessary. However, the company accepts that there are studies showing the benefits created by microprocessor-controlled foot-ankle prostheses. The company has actually cited seven studies in support of its conclusion that microprocessor ankle-feet are “experimental and investigational”. However, every one of those studies concluded that microprocessor ankle-feet provided significant benefits over mechanical ankle-feet.
The lawsuit is ongoing and is in the early stages. If you are a customer of Anthem who suffers from limb loss and had your claim for a prosthesis denied, call me, Conal Doyle, California amputation attorney at 310-385-0567. I am working on the lawsuit and can help. Call today to learn more or to schedule a free consultation.