Category: Amputation

Blue Shield, the health insurance company, was sued in November last year by two customers. The customers are suffering from limb loss and sought prosthetic devices under the terms of their health insurance policies. After failing to get the requested devices, the customers decided to sue. They are seeking to turn the lawsuit into a class action lawsuit and are seeking others who have been similarly affected by the company’s policies.

Blue Shield has been accused of denying coverage for microprocessor-controlled foot prostheses. These are limbs which contain sensors and a computer. The sensors send signals to the computer, which can help the limb react in real-time. This can make a safer and more comfortable experience for the amputee.

According to the lawsuit, computerized foot prosthetic devices have been in use for decades and are considered standard. They are routinely prescribed for many amputees. However, Blue Shield denies all claims for the computerized feet. It labels them as “investigational”. The company references studies on the prosthetic feet, but misstates the conclusions of those studies, according to the lawsuit. The lawsuit alleges that there is more than sufficient evidence that these devices are not “investigational”.

The lawsuit is seeking compensation for amputees who have had their claims wrongfully denied by Blue Shield. If you believe that you may be eligible to join the lawsuit, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. I can help determine if you are eligible to make a claim. Call today to learn more or to schedule a free consultation.

A lawsuit that was filed late last year on behalf of two individuals suffering from limb loss claims that United Healthcare, an insurance company, violated federal law by refusing to pay for some prosthetic limbs. The lawsuit is seeking to be certified as a class action.

The lawsuit alleges that United systematically refused all requests for some prosthetic limbs without any investigation into those requests. Instead, the company simply issued blanket denials without assessing the member’s needs or whether the requested device was necessary.

The lawsuit alleges that the company violated federal law because it acts as a federal fiduciary in administering claims, and it has allegedly wrongfully administered those claims. The lawsuit also claims that the company violated federal law by failing to establish and maintain reasonable claims procedures, and by failing to properly advise claimants regarding why some of their claims were denied.

This lawsuit is only one of several which have been filed against insurance companies in recent months for their failure to pay for prosthetic limbs. If you or a loved one has had your request for a prosthetic limb denied by your insurance company, and you believe that denial was in violation of the policy, call me, Conal Doyle, California amputation attorney, at 310-385-0567. I am currently working on several lawsuits against insurance companies, and I am happy to speak with you about your situation. Call today to learn more or to schedule a free consultation.

If you are an amputee or are suffering from limb loss, and your insurance company denied coverage for a prosthetic limb, you may be eligible to join a lawsuit against the insurance company. Currently, several lawsuits are underway against insurance companies, including United Healthcare, Blue Shield, and Anthem, for their failure to cover prosthetic limbs.

The lawsuits that are currently underway all allege that the insurance companies are refusing to pay for certain types of prosthetic limbs, microprocessor-controlled prosthetic limbs. Microprocessor-controlled limbs used computers and sensors to control the limb instead of just the body. They are more complex than body-powered limbs, and as a result are more expensive. As a result, insurance companies are attempting to exclude coverage for the limbs from their policies.

All three of the lawsuits currently underway are seeking to be certified as class actions. A class action lawsuit is a lawsuit in which there are numerous plaintiffs, all of whom have similar causes of action against one defendant, which in this case is the insurance company. Class action lawsuits are often preferable to individual lawsuits because of the large numbers of plaintiffs involved.

If you are suffering from limb loss, and your insurance company refuses to pay for your prosthetic limb, call me, Conal Doyle, amputation attorney, at 310-385-0567. I can help. I am working on several lawsuits against insurance companies, and you may be eligible to join one of the lawsuits. Call today to learn more or to schedule a free consultation.

United Healthcare was sued late last year for several causes of action related to prosthetic limbs and their refusal to pay for some prosthetic limbs for their customers. Two amputees filed a lawsuit against the company, claiming its practices are in violation of law.

One of the lawsuit’s claims is that United wrongfully refuses to pay for myolectric arms. Myoelectric arms are a type of upper limb prosthetic device which can be used to replace the essential functions of the arm, hand, wrist, and elbow. According to the lawsuit, by the 1980s myoelectric arms were being used in rehab centers around the world. They are commonly issued today for amputees suffering from upper limb loss.

The lawsuit claims that when compared with body-powered limbs, myoelectric arms have superior comfort, aesthetics, and functionality. They give the amputee the ability to move digits through muscle control and are essential for users who want to grasp objects, move their hands with dexterity, and perform the various other essential activities of daily living.

However, according to the lawsuit, United systematically denies all claims for microprocessor limbs, claiming that they are not the most basic device that will meet the member’s needs. The lawsuit claims these policies violate the law.

If you are a customer of United Healthcare, or another insurance company, and your claim for a myoelectric or microprocessor-controlled limb was denied, you should speak with an attorney. Call me, Conal Doyle, at 310-385-0567. I am working on several lawsuits against insurance companies and can help. Call today to learn more or to schedule a free consultation.

A lawsuit that was filed against Blue Shield, the health insurance company, accuses it of wrongful practices in regard to paying for prosthetic limbs. The lawsuit was filed by two amputees whose claims for prosthetic limbs were not properly compensated by Blue Shield. The lawsuit is seeking to become a class action lawsuit so that other amputees who were similarly affected can join.

The lawsuit alleges several ways in which Blue Shield wrongfully avoids paying for expensive prosthetic limbs. Among the claims in the lawsuit is that Blue Shield purposely underpays for prosthetic leg components if those components have been provided and fitted by an out-of-network prosthetist.

According to the lawsuit, Blue Shield has a very small network of in-network prosthetists because it has very low reimbursement rates. As a result, many Blue Shield members cannot find an in-network prosthetist who will work on their artificial limb. Therefore, they are forced to seek the services of an out-of-network prosthetist. This results in the member being forced to pay large amounts of money out-of-pocket in order to receive a prosthesis.

The lawsuit alleges that Blue Shield promises to maintain an adequate network of providers under its policies and has failed to do so because of its low reimbursement rates. The lawsuit is seeking to force Blue Shield to build up a better network of prosthetists, among other things.

If you are a customer of Blue Shield and you have a prosthetic limb, and the company has failed to properly provide you with the prosthetic limb you need, you may be eligible to join this lawsuit. Call me, Conal Doyle, Los Angeles amputation attorney, at 310-385-0567. I can help. I am not only an attorney, I am also an amputee, and I understand many of the challenges you are facing. Call today to learn more.

Two amputees recently sued the Anthem insurance company, claiming that the insurance company wrongfully denied their claims for prosthetic limbs. The company refuses to cover limbs that are not “medically necessary”. The requested limbs were microprocessor-controlled limbs, or limbs that are powered by sensors and an onboard computer.

The plaintiffs both requested that Anthem cover their microprocessor-controlled limbs, which Anthem refused to cover. According to its policies, Anthem does not cover services that are not “medically necessary”. The company has a list of criteria that a service must meet in order to be considered “medically necessary”. One of those criteria is that a service must be:

The most appropriate procedure, supply, equipment or service which can be safely provided. The most appropriate procedure, supply, equipment or service must satisfy the following requirements:

1. There must be valid scientific evidence demonstrating that the expected health benefits from the procedure, supply, equipment or service are clinically significant and product a greater likelihood of benefit, without a disproportionately greater risk of harm or complications, for you with the particular medical condition being treated than other possible alternatives; and
2. Generally accepted forms of treatment that are less invasive have been tried and found to be ineffective or otherwise unsuitable.

The company alleges that microprocessor-controlled prostheses are not medically necessary and denies the scientific evidence about the benefits of the devices. The plaintiffs are seeking compensation for their devices, as well as asking that the lawsuit be certified as a class action so that others who have been similarly affected can join.

If you are suffering from limb loss and your health insurance company has refused to pay for your prosthesis, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation on your case.

A lawsuit was filed in November of last year against Blue Shield, the health insurance company, for its failure to pay for certain types of prosthetic feet for its members. The lawsuit alleges that Blue Shield ignores the numerous benefits of these prostheses, and wrongly labels them as investigational.

The lawsuit specifically refers to microprocessor-controlled foot prostheses. These prosthetic feet respond to constant feedback from sensors embedded in the feet to the onboard computer. The computer than changes the resistance to downward motion and upward motion of the foot based on walking speed, incline, decline, and the type of terrain involved. The foot then makes adjustments in real time. This can help create stability, decrease tumbles and falls, improves ambulation on all surfaces, and decreases the discomfort and pain associated with a prosthetic device.

According to the lawsuit, microprocessor-controlled foot prostheses are now established and accepted by the medical community as standard prostheses and are very routinely prescribed for people who meet certain medical criteria. However, Blue Shield’s policies label these devices as investigational, ignoring the benefits found by numerous studies of the devices.

The lawsuit is seeking damages for those affected by Blue Shield’s policies and is asking the court to order Blue Shield to change its policies going forward. If you have a prosthetic device, and your claim has been denied by Blue Shield, call me, Conal Doyle, Los Angeles personal injury attorney. I am not only an attorney, I am also an amputee. I currently have several lawsuits against insurance companies underway. Call today to learn more or to schedule a free consultation on your case.

In December of last year, two individuals suffering from limb loss sued United Healthcare over its failure to cover certain types of prosthetic limbs. The plaintiffs had their claims for prostheses denied on the basis that the requested limb is not the most basic limb that will meet the individual’s needs.

The amputees sued United Healthcare, claiming that it failed to investigate the situations, and instead simply issued a blanket denial of coverage. The lawsuit claims that United did not assess or determine their functional needs, the minimum limbs that would meet those needs, and failed to identify any alternative prostheses that could meet their needs.

The plaintiffs are asking that the lawsuit be certified as a class action. The plaintiffs are asking that the class include all people covered under United plans whose requests for prosthetic arms and leg devices have been denied on the basis that the requested device was not the most basic device that would meet the individual’s needs. If the lawsuit is certified as a class action, that will allow others whose requests for limbs were denied to join the lawsuit and possibly receive compensation for their damages.

If you use a prosthetic limb, and your request has been denied by United Healthcare or another insurance company, call me, Conal Doyle, amputation attorney, at 310-385-0567. I’m currently in the process of working on several lawsuits against insurance companies for their failure to cover prosthetic limbs. Call today to learn more or to schedule a free consultation on your case.

United Healthcare, a health insurance company, was sued late last year by two individuals suffering from limb loss. The lawsuit alleges that the company issues blanket denials for some types of prosthetic limbs without any type of investigation into whether the limb is needed for the situation. The plaintiffs are seeking to turn the lawsuit into a class action so that other amputees can join the lawsuit.

According to the lawsuit, United has guidelines that determine whether or not certain devices and services are covered under its insurance policies. The guidelines for prosthetic limbs state 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.”

The lawsuit alleges that United uses this guideline to deny all requests for all computer-powered prosthetic arms and leg devices without any investigations. The lawsuit claims that United does not assess or determine the claimant’s needs, how the requested prosthetic device meets the minimum specifications of the claimant’s needs, or identify an alternative device that will meet the claimant’s needs. Instead, United simply issues blanket denials, according to the lawsuit.

The plaintiffs are seeking to turn the lawsuit into a class action and to force the company to change its policies. If you are an amputee and you have had your claims for a prosthetic device denied by your insurance company, 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.

Two amputees sued Blue Shield, alleging that the company’s policies on payment for prosthetic limbs are in violation of its contractual promises. The amputees are seeking to force Blue Shield to change its policies, as well as to receive compensation for their damages.

One of the amputees underwent a leg amputation in 2009 after a car accident. In 2015, he sought help for the problems he was having with his existing prosthetic limb. Under the terms of his insurance policy with Blue Shield, he was required to use an in-network prosthetist in order for the device to be covered. He searched for an in-network prosthetist who could help him with the limb but was unable to find one.

Ultimately, the man obtained the services of a prosthetist who was not an in-network provider for Blue Shield. The prosthetist recommended a below-the-knee device that Blue Shield approved. However, Blue Shield would only pay 37 percent of the prosthetist’s fee, and the man was forced to pay about $18,000 for the limb.

According to the lawsuit, Blue Shield does not have a fully formed network of prosthetists because of its low reimbursement rates. The lawsuit is seeking to force Blue Shield to change its reimbursement rates in order to be able to offer more in-network providers.

If you are an amputee and you have had problems getting your insurance company to pay for your prosthesis, 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.