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Late last year, the Anthem insurance company was sued for failing to pay for microprocessor-controlled foot-ankle prostheses for its customers suffering from limb loss. Microprocessor-controlled prostheses use technology to simulate the movements of a normal foot and ankle. The device responds to constant feedback from sensors to the microprocessor and makes adjustments in real time. Microprocessor-controlled lower limbs are commonly accepted by the medical community at large as “standard” prostheses. They are routinely prescribed for people meeting the appropriate medical criteria. Anthem has developed medical policies that tells whether certain medical treatments are medically necessary and/or investigational. Anthem’s policies are …

Blue Shield of California, the insurance company, was sued late last year. The plaintiffs claimed that Blue Shield’s policies on coverage for prosthetic limbs are incorrect, and the lawsuit is seeking compensation for individuals whose claims for prosthetic limbs have been wrongfully denied. According to the lawsuit, Blue Shield has developed a medical policy called “Microprocessor-Controlled Prostheses for the Lower Limb”. The policy states that microprocessor-controlled feet are considered investigational. However, according to the lawsuit, the medical policy misstates the studies regarding microprocessor-controlled foot prostheses. The lawsuit claims that there is ample evidence about the effectiveness of microprocessor-controlled foot prostheses. …

Two individuals who suffered limb loss recently sued Blue Shield of California, claiming their prostheses were not properly covered under the terms of the insurance policies. One member had his claim for a microprocessor-controlled prosthesis denied by the company. The other member had to use an out-of-network prosthetist and had to pay extensive out-of-pocket costs due to the lack of availability of in-network prosthetists. Those two individuals sued Blue Shield and are seeking to make the lawsuit a class action lawsuit. In the case, the plaintiffs are asking that Blue Shield be forced by the court to take five actions. …

Late last year, three lawsuits were filed against three separate health insurance companies for their failures to pay for microprocessor-controlled prosthetic limbs. The three health insurance companies that were sued are Anthem, Blue Shield of California, and United Healthcare. All three insurance companies have denied coverage for microprocessor-controlled limbs for their customers. The insurance companies typically claim that they are investigational, not medically necessary, or that the insurance company is not obligated to pay for those limbs when cheaper limbs are available. Microprocessor-controlled limbs use microprocessors to power the artificial limbs. Manufacturers have developed lower leg devices that are much …

Two people who suffered from limb loss and who were covered by Anthem health insurance company sued the company because it failed to provide certain prostheses. The company labeled microprocessor-controlled knee and foot-ankle prostheses as “investigational” and refused to provide coverage. As of the time of filing the lawsuit, the company labeled all microprocessor-controlled foot-ankle prostheses as “investigational and not medically necessary for all indications. Under the terms of the insurance policies issued, the company is not responsible for paying for medical devices and treatments that are investigational. The company labels “investigational” services as services that meet one of seven …

A lawsuit filed against Blue Shield of California, an insurance company, is seeking to be certified as a class action lawsuit. A class action lawsuit is one in which multiple individuals with similar complaints against the same defendants can join together in one large lawsuit instead of being forced to bring individual lawsuits. Two individuals who have suffered from limb loss are bringing this lawsuit against Blue Shield. One of the individuals had an amputation of his left leg and sought authorization from Blue Shield for a microprocessor-controlled foot prosthesis. Blue Shield denied the claim on the basis that a …

The mother of a 12-year-old boy who was denied coverage for a certain type of prosthesis sued the United Healthcare, the insurance company that denied coverage. The lawsuit is seeking other plaintiffs who have had their requests for prostheses denied by United Healthcare. The boy suffers from a congenitally-acquired absence of his right forearm and hand. As he grows, he requires both hands to perform everyday functions as an active 12-year-old boy. A prosthetist recommended that he be given a microprocessor-controlled device which simulates a human hand by providing the six fundamental grips of the human hand. United Healthcare denied …

According to a lawsuit filed towards the end of 2017, Blue Shield of California, a health insurance company, has been wrongfully denying coverage for some lower limb prosthetic devices for individuals suffering from limb loss. The lawsuit also alleges that Blue Shield has been restricting payment for lower limb devices, which forces members to use out-of-network prosthetists. The lawsuit is asking that the court order Blue Shield to take five actions: (1) stop its practice of categorically denying all requests for microprocessor-controlled foot prostheses; (2) notify class members that its decision to deny requests for all microprocessor-controlled foot prostheses was …

According to a lawsuit filed late last year, Blue Shield of California is wrongfully maintaining an inadequate network of prosthetists. The lawsuit is seeking compensation from the company for its wrongful actions. Two individuals who suffered from lower limb loss who were customers of Blue Shield of California sued the company. According to Blue Shield’s written policies, the Blue Shield health plan is designed for its members to obtain services from participating providers. If a member chooses to get medical services from non-participating providers, the member will typically have a higher out-of-pocket expense. The lawsuit claims that implicit in the …

Two people suffering from limb loss sued Anthem, a health insurance company. According to the lawsuit, Anthem wrongfully denied coverage for all devices, claiming they are “investigational and not medically necessary for all indications”. The plaintiffs claim that the devices are not investigational and are necessary for people who have limb loss. According to the lawsuit, microprocessor-controlled foot-ankle devices use technology to simulate the movements of a normal foot and ankle. They respond to constant feedback from sensors to the microprocessor. The microprocessor then changes the resistance to downward motion and upward motion of the foot based on incline, decline, …

Two customers of United Healthcare, a health insurance company, sued the company for providing only minimum prostheses to its plan members. The plaintiffs are seeking compensation for their prostheses as well as seeking other plan members who have had claims for prostheses denied to join the lawsuit. One of the customers was an active man in his 20s. He worked as an account manager and had an active lifestyle with hobbies that included jogging, hiking, and mountain biking. Because of his lifestyle, prosthetists recommended that he be given a below the knee device that included a Trans-tibial High-Fidelity Interface (socket) …

Two amputees recently sued Blue Shield of California, a health insurance company. One of the men had a leg amputation in 2011. In 2016, he needed a new prosthetic device, and sought authorization from Blue Shield for a microprocessor-controlled foot prosthesis. The request was denied. The other plaintiff had an amputation in 2009, and in 2015 he needed a new prosthesis. He was unable to find an in-network prosthetist who could give him a suitable device and was forced to pay large amounts out-of-pocket for the device. The plaintiffs are seeking to make their lawsuit a class action and are …