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Several lawsuits have been filed against insurance companies recently for their failure to cover prosthetic limbs. The lawsuits claim that the insurance companies have wrongfully denied coverage for prosthetic limbs that are controlled by microprocessors. The insurance companies claim they aren’t medically necessary or are experimental. There are roughly two million people living with limb loss in the U.S. About 185,000 amputations are performed in the U.S. each year. Those amputees need a prosthesis, which replaces the missing body part, such as the arm of leg. Technology improvements have allowed prosthesis manufacturers to use microprocessors to power artificial knees, feet, …

Late last year, three lawsuits were filed against insurance companies by individuals suffering from limb loss. The insurance companies allegedly refused to pay for prosthetic limbs that should have been covered. All three lawsuits are seeking to become class action lawsuits. It is expected that more lawsuits are to follow. The three companies that were sued are Anthem, United Healthcare, and Blue Shield. The lawsuits were filed in California. In each of the lawsuits, two customers of the insurance company sued the company for failing to properly pay for a prosthetic limb. Each situation is different, but most involve the …

Two customers of Blue Shield, the insurance company, have sued the company. The lawsuit alleges that Blue Shield has a very small network of prosthetists because of its low reimbursement rates. The lawsuit further alleges that many customers of Blue Shield who are suffering from limb loss are forced to pay out of pocket for their prosthetic limbs as a result. The plaintiffs are two men who are suffering from limb loss. One of the men was a customer of Blue Shield and in 2015 he sought help for problems he was experiencing with his prosthetic limb. He was unable …

Blue Shield was sued late last year for its practice of failing to pay for some artificial limbs requested by customers. The limbs that are being denied are microprocessor-controlled limbs which are controlled by computers rather than the human body. The plaintiffs claim that the limbs have been standard for decades and that Blue Shield is acting in bad faith by denying them. Blue Shield alleges that the limbs are “experimental or investigational in nature”. Blue Shield excludes coverage for services or supplies that are “Experimental or Investigational in Nature”. That phrase is defined as: Experimental or Investigational in Nature …

Two individuals who lost limbs and were customers of Anthem have sued the company, alleging that the company wrongfully labeled artificial limbs as “investigational” and therefore refused to pay for them. The plaintiffs claim that the limbs are not investigational and that the company should be forced to provide them. In its insurance policies, Anthem does not cover services that are “investigational”. Anthem defines investigational services as: Services that have limited use on humans, which are not generally accepted as proven and effective procedures within the organized medical community; Services that do not have final approval from the appropriate governmental …

Two customers of Blue Shield have sued the insurance company for its failure to provide some prosthetic limbs to its customers. The plaintiffs are asking that the court make the lawsuit a class action. The plaintiffs are men who both lost their legs in automobile accidents and have insurance provided by Blue Shield. One of the plaintiffs had his request for a prosthetic limb denied. The other plaintiff was forced to go to an out-of-network prosthetists to have a limb made, which resulted in large out-of-pocket expenses for him. The plaintiffs are seeking to certify the lawsuit as a class …

Anthem, a health insurance company, was recently sued in a class action lawsuit. The plaintiffs are individuals suffering from limb loss who had their claims for prosthetic limbs denied by Anthem. The plaintiffs are seeking to find other individuals whose claims have been denied by Anthem in order to proceed as a class action. According to the lawsuit, when a customer of Anthem requests a microprocessor-controlled knee prosthesis, Anthem denies the request on the basis that the knee is not medically necessary. The plaintiffs claim that the devices are effective and necessary for people with lower limb loss. Microprocessor-controlled knees …

Two individuals suffering from limb loss sued United Healthcare, a health insurance company, claiming that the company automatically denies claims for prosthetic limbs without investigation, in violation of the Employee Retirement and Security Act of 1974. The individuals are seeking compensation for their prosthetic limbs and are asking that the company change its policies going forward. The plaintiffs brought the case on behalf of themselves and others whose claims for prosthetic arm and leg devices have been denied by United Healthcare on the basis that the requested devices “do not meet the minimum specifications of the enrollees needs. United Healthcare …

A customer of Blue Shield was forced to pay a large portion of the cost of his prosthetic limb out-of-pocket, despite being insured by Blue Shield. The man sued Blue Shield, seeking to be reimbursed for his expenses, as well as to force the company to change its policies regarding coverage for prosthetic limbs. The man had his left leg amputated below the knee in 2009 as the result of an automobile accident. In 2015 he needed a new prosthetic device. He looked for an in-network prosthetist who could help provide him with a new device but was unable to …

United Healthcare, a large insurance company, was sued in court in California late last year for its failure to provide coverage for some types of prosthetic limbs. The company was sued by two people who are suffering from limb loss whose claims for limbs were denied. The company issued denials for the plaintiffs’ limbs that were requested. The plaintiffs sought coverage for microprocessor-controlled limbs, which are artificial limbs that are controlled by computer chips. The limbs have been standard for decades. The company issued the denials on the basis that the limbs exceed the minimum standards for the plaintiffs’ needs. …

Late last year, two customers of Blue Shield sued the company, alleging that it wrongfully failed to pay for microprocessor-controlled prosthetic limbs. The lawsuit alleges that the company wrongfully claimed that the limbs are not medically necessary and are investigational. Blue Shield pays for the cheaper limbs, which are body-controlled. The lawsuit lays out in detail the benefits of microprocessor-controlled limbs for people with lower limb loss in ordinary settings. Some of the benefits of microprocessor foot prostheses include: They respond to constant feedback. This helps the foot change resistance to downward and upward motion in real time. They reduce …

Anthem, a health insurance company, was recently sued by two of its customers who have lost a limb. In their lawsuit, the customers claim that the company is wrongfully denying all requests for certain types of foot-ankle prostheses. The plaintiffs are seeking to make the lawsuit a class action suit so that others who have been similarly affected by Anthem can join the lawsuit. The lawsuit claims that the company uses its own policies to deny coverage for all requests for microprocessor-controlled foot-ankle prostheses. Microprocessor-controlled prostheses have sensors, a microprocessor, software, and a battery. The other types of prostheses are …