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 find one. He was forced to go to a prosthetist who was out of network. He ended up paying $18,000 out of pocket for his prosthetic limb. Blue Shield only paid 37 percent of the prosthetist’s fee because the prosthetist was out of network.
According to the lawsuit, Blue Shield did not properly form a fully developed network of prosthetists as it should have. Blue Shield had very low contracted rates for providers, which forced the vast majority of prosthetists to refuse to sign a contract with Blue Shield. The lawsuit claims that Blue Shield had promised its customers that it would provide a network of providers, which it failed to do.
If you are or were a customer of Blue Shield, and the company failed to properly pay for your prosthesis, resulting in you either being forced to pay out of pocket or receiving an inferior product, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation on your case.