In September of 2017, Anthem was sued in a class action lawsuit in California for failing to provide coverage for microprocessor controlled lower limb prostheses for amputees who had lost a lower limb. The lawsuit alleges that Anthem has determined the devices are “not medically necessary” and are “investigational”. The lawsuit claims that the devices are effective and are also necessary for amputees who have lost a lower limb.
The two types of lower limb prostheses are above the knee prostheses and below the knee prostheses. Manufacturers of both devices now use microprocessors to power artificial knees as well as feet-ankles in those devices. According to the lawsuit, microprocessors have been standard in the devices for some time. Microprocessor controlled devices improve stability, decrease the number of falls, and improve ambulation on all surfaces.
However, Anthem alleges that microprocessor controlled lower limbs are not medically necessary and are investigational. Microprocessor controlled devices are more expensive than other types of limbs, but can provide huge benefits to an amputee. The lawsuit alleges that Anthem has denied coverage for the limbs using erroneous criteria.
If you are an amputee and were denied coverage of a microprocessor-controlled limb, you may be eligible to join the class action lawsuit. You may have other legal options as well. Call me, Conal Doyle, Los Angeles personal injury attorney at 310-385-0567. I can help you investigate your legal options.