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Some customers of Anthem, a health insurance company, have sued the company in California, claiming that its policies wrongfully deny prosthetic limbs to some amputee customers. The amputees allege that the company has wrongfully labeled some limbs as “investigational” in spite of studies that show otherwise. The lawsuit alleges that the company has refused to pay for microprocessor-controlled prosthetic limbs. Those limbs are controlled by computer chips instead of the human body and can result in significant benefits to users. They are much more expensive than limbs that are controlled by the body, and as a result many insurance companies …

A lawsuit that was filed last year by customers of Blue Shield who are suffering from limb loss made several allegations against the company, claiming that it is violating the terms of its contracts with customers in several ways. One of the allegations contained in the lawsuit is that the company wrongfully has a very small network of prosthetists, which results in individuals who need artificial limbs often being forced to pay a large percentage of the cost out of their own pockets. According to the lawsuit, Blue Shield’s contract with its customers has language about in-network providers. The contract …

Two individuals who are suffering from limb loss sued United Healthcare in California, claiming that the company wrongfully denied their claims for prosthetic limbs without properly investigating their situation. They are asking the court to certify the lawsuit as a class action so that other individuals whose claims for prostheses have been wrongfully denied by United can join in on the lawsuit. United Healthcare has written guidelines that it uses to implement its insurance policies. One of those guidelines is called “Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs”. That guideline states that “If more than one prosthetic device can …

Currently, there are lawsuits underway against Blue Shield, Anthem, and United Healthcare for their failure to provide certain types of prosthetic limbs to their members. The lawsuits are seeking damages and may be certified as class actions. The lawsuits were all filed late last year. All allege that the insurance companies involved refused to pay for microprocessor-controlled prosthetic limbs. Microprocessor-controlled limbs use computers to control the limbs, using feedback from the limb. The other type of common prosthetic limbs is body-powered limbs, which have been shown to be more painful and cumbersome for users. The insurance companies generally label the …

Late last year, two amputees sued the Anthem insurance company in California, alleging that the company wrongfully failed to provide proper artificial limbs for them. The amputees asked that the company be required to pay for certain prosthetic limbs going forward, and that the company reimburse them for their prostheses. According to the lawsuit, Anthem insurance plans exclude “investigational” services. The company defines “investigational” services as services: (1) that have progressed to limited use on humans, which are not generally accepted as proven and effective procedures within the organized medical community; or (2) that do not have final approval from …

Anthem, a company that provides health insurance, was recently sued for refusing to provide coverage for some prosthetic devices for some of its customers. The plaintiffs are seeking to turn the lawsuit into a class action and to force the company to pay for the devices. The devices that are being excluded are microprocessor-controlled devices, which are prosthetic limbs controlled by a computer instead of by the body. Anthem has issued medical policies to administer their claims. The plans specifically exclude coverage for any devices or services that are not “medically necessary” or are “investigational”. The insurance plans specifically label …

Late last year, two individuals suffering from limb loss who were customers of Blue Shield sued the company over its failure to pay for certain types of prosthetic limbs. The customers claim that the company acted in bad faith in refusing to pay their claims. They are seeking to turn the lawsuit into a class action and to force the insurance company to reimburse them, as well as to pay for the limbs going forward. The limbs that the company has refused to provide are microprocessor-controlled limbs. They are limbs that are operated by a computer. They can change the …

United Healthcare has been sued for refusing to provide an amputee with a complex prosthetic limb. The insurance company claimed that the amputee was only able to receive the “most basic leg” that met his needs. He sued the company and is seeking to have the lawsuit certified as a class action. The man underwent a below the knee amputation of his left leg that resulted from severe injuries he suffered in an accident in 2017. When the accident occurred, the man was in his mid-20s and was working as an account manager. He had an active lifestyle that included …

A lawsuit was filed last year against Blue Shield of California for its failure to properly pay for some prosthetic limbs, as well as for its failure to build up a network of providers who can make prosthetic limbs. The plaintiffs are seeking compensation for their losses, as well as to certify the lawsuit as a class action. Specifically, the plaintiffs are seeking for two classes of individuals to be certified: All persons covered under Blue Shield of California non-ERISA health plans whose request for microprocessor-controlled foot prostheses have been or will be denied during the applicable statute of limitations …

A series of recent lawsuits filed against insurance companies in California claim that insurance companies are wrongfully refusing to provide microprocessor-controlled prosthetic limbs. The insurance companies are claiming they are investigational or “not medically necessary”, among other claims. According to the lawsuits, microprocessor technology has been used in prosthetics for decades and has become standard in the industry. Microprocessor-controlled lower limbs feature sensors, a microprocessor, software, a resistance system, and a battery. They use technology to monitor a person’s gait using sensors. The sensors detect and monitor changes in the environment, such as going up or down a slope or …

Late last year, two customers of Blue Shield, a health insurance company, sued the company for its policies on prosthetic limbs. Among the causes of action listed in the lawsuit is the allegation that the company failed to keep enough in-network prosthetists, who are individuals who make prosthetic limbs. According to the lawsuit, this has forced some customers of Blue Shield to pay out-of-pocket for their limbs. Blue Shield has entered into contracts with its customers. Each contract is called an evidence of coverage (“EOC”). One of the company’s EOCs provides that: The Blue Shield health plan is designed for …

United Healthcare, a health insurance company, has been sued for refusing to pay claims for prosthetic limbs. According to the lawsuit, the company uses its internal policies to avoid paying legitimate claims for certain types of prostheses. The lawsuit alleges that the company refuses to pay for microprocessor-controlled limbs for its customers. Microprocessor-controlled limbs use computer chips to help operate the limb. According to studies, they are commonly used and offer users many benefits over body-powered limbs. The lawsuit alleges that United has developed Coverage Determination Guidelines, which are written positions on whether certain medical treatments are covered or excluded …