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, there have been a number of studies that show that microprocessor-controlled foot prostheses provide significant benefits over mechanical feet. There is also a great deal of evidence showing how effective the devices are. They respond to feedback from sensors, which can allow for a more normal bend at the ankle when walking. This can help create better stability and reduces stumbles and falls. The lawsuit alleges that the benefits of microprocessor devices have been well documented and are well known to Blue Shield.
If you are suffering from limb loss and your insurance company has refused to pay for your prosthesis, call me, Conal Doyle, amputation attorney, at 310-385-0567. Currently I’m involved in several lawsuits against insurance companies that are not providing coverage for microprocessor limbs. Call today to learn more or to schedule a consultation.