Anthem, the health insurance company, was sued last year by two individuals suffering from limb loss. They sued Anthem for its failure to provide microprocessor-controlled prosthetic devices, which are devices controlled by computer chips. Instead, the company will only cover body-powered devices. The lawsuit is seeking to be certified as a class action lawsuit so that others who are similarly affected can join.
According to the lawsuit, Anthem incorrectly denies requests for microprocessor knee prostheses. Anthem has deemed requests for those devices as “not medically necessary” unless the following criteria are met:
- The individual has adequate cardiovascular reserve and cognitive learning ability to master the higher level technology and to allow for faster than normal walking speed; and
- The individual has demonstrated the ability to ambulate faster than their baseline rate using a standard swing and stance lower extremity prosthesis; and
- The individual has a documented need for daily long distance ambulation at variable rates; and
- The individual has a demonstrated need for regular ambulation on uneven terrain or regular use on stairs (excluding home and work).
The lawsuit alleges that these four criteria are erroneous. Microprocessor legs are primarily used to accomplish the normal activities of daily living, not to engage in athletic endeavors. The lawsuit is asking that Anthem reimburse the plaintiffs for their artificial limbs, as well as to change its plans going forward to cover those devices.
If you are a customer of Anthem or another insurance company, and your request for a prosthesis has been denied, you should speak with an attorney. Call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation.