Blue Shield Sued over Its Written Policies on Artificial Prosthetic Limbs

Blue Shield, the health insurance company, was sued late last year over its policies for coverage of prosthetic limbs. Two amputees sued the company, claiming that it has been wrongfully denying payments for some prostheses for its customers. The plaintiffs are asking that the court certify the lawsuit as a class action.

According to the lawsuit, Blue Shield is failing to reimburse customers for their lower limb prostheses that are a certain type, microprocessor-controlled. Those prostheses cost more than other, simpler prostheses, and many insurance companies try to avoid covering their cost.

Blue Shield has developed and implemented a written Medical Policy called “Microprocessor-Controlled Prostheses for the Lower Limb”. It states that microprocessor-controlled or powered foot is considered investigational. However, the plaintiffs claim that Blue Shield misstates the impact of some studies of the benefits of this device and ignores other studies that support microprocessor foot-ankle technology.

The lawsuit claims that there is more than sufficient evidence of the effectiveness of microprocessor-controlled limbs. They respond to feedback and allow for a more normal bend at the ankle. They normally reduce pain and reduce stumbles and falls.

If you are a customer of Blue Shield and the company failed to pay for your prosthetic device, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I’m working on several of these lawsuits and am happy to speak with you. Call today to learn more or to schedule a free consultation on your case.