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United Healthcare Sued for its Failure to Tell Customers why Some Claims were Denied

United Healthcare is currently facing a lawsuit from two of its customers who are suffering from limb loss. Those individuals asked for prosthetic limbs from the company, and the company issued a denial with very little information. The plaintiffs are seeking to make the lawsuit a class action lawsuit. They are asking the court to force the company to change its policies. The plaintiffs both sought payment for microprocessor-controlled artificial limbs. Those limbs use microprocessors to power the limb instead of using the body. United denied those claims. In issuing its denial, the company alleged that the limb requested did …

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Anthem Health Labels Some Artificial Limbs as “Investigational”, Facing Lawsuit

Two people suffering from limb loss sued the Anthem health insurance company for its failure to pay for their artificial limbs. The company labeled the limbs as “investigational” and was sued as a result. According to Anthem’s internal guidelines, the company will not cover any “investigational” services. The company uses seven criteria to determine if a service is investigational: 1. It has limited use on humans, which is not generally accepted as proven and effective procedures within the organized medical community; 2. It does not have final approval from the appropriate governmental regulatory body; 3. It is not supported by …

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United Healthcare Sued for its Failure to Provide Myolectric Arms

Late last year, two amputees sued United Healthcare on behalf of themselves and others. United Healthcare, a health insurance company, has refused to pay for myoelectric artificial arms for its customers. The customers claim that the company has acted in bad faith in its refusal to provide coverage. According to the lawsuit, by the 1980s myoelectric arms were in use in rehabilitation centers around the world. They are commonplace today. Myoelectric arms have much better comfort, functionality, and appearance when compared with arms that are powered by the body. In addition, myoelectric arms are essential for the various activities of …

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Amputees Sue Blue Shield over its Very Small Network of Prosthetists

Two amputees have sued Blue Shield, a health insurance company, over its failure to maintain a well-developed network of prosthetists, among other allegations. The amputees claim that the company so poorly reimburses prosthetists that it has a very small network of them, which leads to the amputees being forced to pay large amounts out-of-pocket for prosthetic limbs. Under Blue Shield’s guidelines, their health plans are designed for members to receive services from participating providers, or in-network providers. If members choose to use out-of-network providers, Blue Shield will pay a much smaller portion of the expense. The lawsuit alleges that implicit …

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Mother of 12-Year-Old Born without Arm Sues United Healthcare for Lack of Prosthesis Coverage

The mother of a 12-year-old son sued her health insurance company, United Healthcare, because of its failure to provide the proper prosthetic arm for her son. The company claimed that the device requested was not the most basic limb that would meet the boy’s needs. The boy was born without a right forearm and hand. As he grows, he requires new prosthetic devices that will fit his body. His lifestyle requires the use of both hands to perform everyday functions such as typing, eating, and holding objects, such as his trumpet. A prosthetist recommended that he receive an i-limb quantum …

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Amputees Bringing Lawsuits Against Insurance Companies

Late last year, six individuals suffering from limb loss sued three insurance companies, United Healthcare, Anthem, and Blue Shield. In the lawsuits, the plaintiffs claimed that the companies were wrongfully denying coverage for microprocessor-controlled limbs to their customers. The plaintiffs are seeking to turn all three lawsuits into class action lawsuits. Class actions are often best for situations where several factors are present. First, there normally must be such a large number of class members that it would not be practical for them to sue individually. All of the plaintiffs must have common issues of law and fact. Any named …

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Mother of Five Denied Prosthetic Knee, Sues Health Insurance Company

A mother of five sued the Anthem insurance company, claiming that the company wrongfully denied her claim for a prosthetic knee. She is seeking to turn the lawsuit into a class action on behalf of others whose prostheses were denied. The plaintiff had her left leg amputated above the knee when she was 11 years old. She is married with five children and has insurance coverage through Anthem. In 2016, she was referred to a nationwide provider of prosthetic services, which determined that she needed a prosthetic leg with a microprocessor-controlled knee. The prosthetist sought authorization from Anthem for the …

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United Healthcare Sued for Denying Prosthetic Devices without Investigating Situation

Two individuals who have lost limbs and were insured by United Healthcare sued the insurance company. The plaintiffs claimed that the company has been issuing blanket denials on certain types of prosthetic devices without investigating the situation. United has a guideline that it uses to determine coverage for prosthetic devices. The guideline states that “If more than one prosthetic device can meet the member’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications for the member’s needs.” According to the lawsuit, the company uses that provision to systematically deny coverage for prosthetic arm and …

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Anthem Insurance Company Sued for Denying Coverage for Some Prostheses Using Faulty Information

Late last year, some customers of Anthem, a medical insurance company, sued the company for its failure to provide certain types of prosthetic limbs. The company has denied coverage for microprocessor-controlled devices, which are prostheses which are controlled by a computer rather than simply powered by the human body. Anthem denied coverage for those devices, claiming that they are investigational and not medically necessary for all indications. The documentation issued by the company acknowledges that there are studies which show the benefits provided by microprocessor-controlled foot-ankle prostheses. The company’s documentation actually cites seven different studies in support of its conclusion …

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Blue Shield Sued for Using Medical Policies to Deny Coverage for Microprocessor-Controlled Foot Prostheses

Two individuals suffering from limb loss have sued Blue Shield of California for its failure to cover certain types of prosthetic devices. The devices Blue Shield does not cover are microprocessor-controlled devices, which are powered by computers and provide a number of benefits for users. Instead, Blue Shield covers body-powered devices, which can be painful and more difficult to use. Blue Shield has a written coverage position called the Medical Policy for “Microprocessor-Controlled Prostheses for the Lower Limb”. The document says that microprocessor-controlled prostheses are considered investigational, and therefore Blue Shield will not cover them. However, according to the lawsuit, …

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Amputees Sued United Healthcare, Requesting the Company Start Covering Prostheses

Two amputees who were covered by health insurance from United Healthcare have sued the company. The amputees claim that the company wrongfully refused to provide coverage for certain types of prostheses. The amputees are seeking to turn the lawsuit into a class action and to force the company to begin providing more coverage for prostheses. The amputees are claiming that United Healthcare refuses to provide coverage for microprocessor-controlled prostheses. Those limbs are powered by microprocessors that react to stimuli in real time. Instead, the company provides only body powered limbs, which are much less expensive but pose more problems for …

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Blue Shield Sued for Failure to Provide Proper Prostheses for Activities of Daily Living

Blue Shield of California was recently sued for failing to provide certain types of artificial limbs to its members suffering from limb loss. Two of its members sued the company for its failure to properly compensate for artificial limbs. The company’s written guidelines on coverage provided that “benefits are provided for Prostheses for Activities of Daily Living at the most cost-effective level of care that is consistent with professionally recognized standards of practice.” However, the company has refused to pay for microprocessor-controlled prostheses. It claims that the limbs are investigational, although there have been studies showing that the devices provide …

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