Category: Amputation

Two customers of Blue Shield have sued the insurance company for its failure to provide some prosthetic limbs to its customers. The plaintiffs are asking that the court make the lawsuit a class action.

The plaintiffs are men who both lost their legs in automobile accidents and have insurance provided by Blue Shield. One of the plaintiffs had his request for a prosthetic limb denied. The other plaintiff was forced to go to an out-of-network prosthetists to have a limb made, which resulted in large out-of-pocket expenses for him.

The plaintiffs are seeking to certify the lawsuit as a class action, which would allow them to represent the interests of many individuals who have had similar issues with Blue Shield. They are asking that the court certify two classes: (1) all people covered under Blue Shield of California non-ERISA health plans whose requests for microprocessor-controlled foot prostheses have been or will be denied because they are “investigational”, and (2) all people covered under Blue Shield non-ERISA health plans whose requests for prosthetic lower limb devices were paid by Blue Shield to out-of-network providers.

In order to certify a lawsuit as a class action, the plaintiffs must show that there are numerous members of the potential class, that all members can be ascertained, that common questions of law and fact exist as to all members of the class, that the plaintiffs’ claims are typical of the claims of other class members, that the plaintiffs will fairly protect the interest of the members and have competent and experienced attorneys, that if the lawsuit is not a class action there could be inconsistent verdicts with various cases, and that Blue Shield has acted similarly with respect to all class members.

This case as well as several others are pending, and all are seeking to be class action lawsuits. If you are a customer of an insurance company, and that company has failed to provide coverage for your prosthesis, call me, Conal Doyle, personal injury attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation on your case.

Anthem, a health insurance company, was recently sued in a class action lawsuit. The plaintiffs are individuals suffering from limb loss who had their claims for prosthetic limbs denied by Anthem. The plaintiffs are seeking to find other individuals whose claims have been denied by Anthem in order to proceed as a class action.

According to the lawsuit, when a customer of Anthem requests a microprocessor-controlled knee prosthesis, Anthem denies the request on the basis that the knee is not medically necessary. The plaintiffs claim that the devices are effective and necessary for people with lower limb loss.

Microprocessor-controlled knees have sensors, microprocessors, software, a battery, and a resistance system. The knee has a computer which controls internal fluid. The computer uses sensors to monitor each phase of a user’s gait cycle. Based on the feedback, the computer adjusts the resistance to knee bending and straightening to accommodate walking speed and terrain, which can enhance stability for the user, decrease falls, and provide other benefits. Microprocessor knees are primarily for walking around, not engaging in athletics.

As you might imagine, microprocessor-controlled knees are more expensive than other, less sophisticated types of limbs. If you have suffered from limb loss and Anthem or another insurance company has refused to provide you with the limb you need, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. Currently, my team is working on several lawsuits against insurance companies for their failure to provide proper coverage for prosthetic limbs. Call today to learn more.

Two individuals suffering from limb loss sued United Healthcare, a health insurance company, claiming that the company automatically denies claims for prosthetic limbs without investigation, in violation of the Employee Retirement and Security Act of 1974. The individuals are seeking compensation for their prosthetic limbs and are asking that the company change its policies going forward.

The plaintiffs brought the case on behalf of themselves and others whose claims for prosthetic arm and leg devices have been denied by United Healthcare on the basis that the requested devices “do not meet the minimum specifications of the enrollees needs. United Healthcare has developed policies about what it will and will not cover. One policy involved prosthetic limbs, and states “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 of the member’s needs.”

According to the lawsuit, pursuant to its policies, United Healthcare has systematically denied claims for prosthetic arm and leg devices without assessing or determining the claimant’s functional needs, without assessing or determining how a prosthetic device meets the “minimum specifications” of the claimant’s needs, and without ascertaining or identifying if an alternative device will meet the “minimum specifications” of the claimant’s needs.

If you have had your claim for a prosthetic limb denied by United Healthcare, call me, Conal Doyle, Amputation Attorney. I am not only a personal injury attorney, I’m also an amputee, and I am currently working on several cases against insurance companies. Call me today at 310-385-0567.

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.

United Healthcare, a large insurance company, was sued in court in California late last year for its failure to provide coverage for some types of prosthetic limbs. The company was sued by two people who are suffering from limb loss whose claims for limbs were denied.

The company issued denials for the plaintiffs’ limbs that were requested. The plaintiffs sought coverage for microprocessor-controlled limbs, which are artificial limbs that are controlled by computer chips. The limbs have been standard for decades. The company issued the denials on the basis that the limbs exceed the minimum standards for the plaintiffs’ needs. The insurance company’s policy is that it will only cover prosthetic devices that meet the minimum specifications for the customer’s needs.

The lawsuit claims that United Healthcare simply issued a blanket denial for the limbs without examining the plaintiffs’ situations in any detail. According to the lawsuit, United Healthcare simply saw that a more complex limb was being requested and issued a denial without examining the facts of the situation.

The plaintiffs are seeking to force the company to change its policies, as well as to force the company to pay for their limbs and to compensate them for other expenses. The lawsuit may be a class action lawsuit, which could help other amputees whose claims have been denied by United Healthcare. If you have had a claim for a prosthesis denied by United Healthcare, call me, Conal Doyle, personal injury attorney, at 310-385-0567. I currently have several lawsuits underway against insurance companies, and I am happy to speak with you about your situation. Call to learn more or to schedule a free consultation.

Late last year, two customers of Blue Shield sued the company, alleging that it wrongfully failed to pay for microprocessor-controlled prosthetic limbs. The lawsuit alleges that the company wrongfully claimed that the limbs are not medically necessary and are investigational. Blue Shield pays for the cheaper limbs, which are body-controlled.

The lawsuit lays out in detail the benefits of microprocessor-controlled limbs for people with lower limb loss in ordinary settings. Some of the benefits of microprocessor foot prostheses include:

• They respond to constant feedback. This helps the foot change resistance to downward and upward motion in real time.
• They reduce toe drag, which helps with balance.
• They create stability for the user, which decreases stumbles and falls.
• They improve ambulation on all surfaces.
• They decrease the discomfort and pain caused by a prosthetic device.

According to the lawsuit, these benefits have all been proven by scientific studies. The lawsuit also alleges that these devices have been accepted by the medical community for years. However, Blue Shield still claims that the devices are investigational and not medically necessary.

If you are suffering from limb loss, and your insurance company refuses to pay for your prosthetic limb, you should speak with an attorney. Call me, Conal Doyle, at 310-385-0567. I’m currently involved in several lawsuits against insurance companies and will be happy to speak with you. Call today to learn more or to schedule a free consultation on your case.

Anthem, a health insurance company, was recently sued by two of its customers who have lost a limb. In their lawsuit, the customers claim that the company is wrongfully denying all requests for certain types of foot-ankle prostheses. The plaintiffs are seeking to make the lawsuit a class action suit so that others who have been similarly affected by Anthem can join the lawsuit.

The lawsuit claims that the company uses its own policies to deny coverage for all requests for microprocessor-controlled foot-ankle prostheses. Microprocessor-controlled prostheses have sensors, a microprocessor, software, and a battery. The other types of prostheses are body-controlled and have been proven to be less effective and more painful for the user than microprocessor-controlled prostheses, which can react in real-time to changes in the environment.

According to the lawsuit, microprocessor-controlled prostheses have been established and accepted by the medical community as “standard” prostheses. Anthem has written policies which exclude microprocessor-controlled prostheses. One policy states that “The use of a microprocessor controlled foot-ankle prosthesis (for example, Proprio Foot of the PowerFoot Biom) is considered investigational and not medically necessary for all indications.”

The customers are suing Anthem, seeking to force the company to change its policies to cover microprocessor-controlled prostheses. If you are or were a customer of Anthem, and the company refused to cover a prosthetic limb for you, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am currently working on three lawsuits against insurance companies and I will be happy to provide you with a free consultation. Call today to learn more.

Three insurance companies were sued late last year for failing to pay for microprocessor-controlled prosthetic limbs. Those companies have claimed that the limbs are experimental or not medically necessary, despite evidence to the contrary. The lawsuits are seeking compensation for amputees who have had their claims denied, as well asking that the companies be forced to change their policies.

Currently, there are about two million people living with limb loss in the U.S. About 500 people a day, or 185,000 a year, have limbs amputated. People with limb loss require a prosthesis, which replaces a missing body part. For lower limb prostheses, there are two types: transfemoral (above the knee) and transtibial (below the knee).

In recent decades, technology has progressed so that manufacturers can use microprocessors to power artificial knees and feet in the devices. Microprocessor-controlled devices are more expensive than body-powered devices, and therefore many insurance companies are reluctant to pay for them. Many insurance companies label them as experimental, despite numerous studies showing all the benefits they offer amputees, including increasing stability, decreasing falls and pain, and improved ambulation on all surfaces. Amputees have begun suing insurance companies for violating the terms of their contracts by failing to provide coverage for those devices.

If you have suffered limb loss and your insurance company is refusing to provide coverage for a microprocessor limb, call me, Conal Doyle, personal injury attorney, at 310-385-0567. I am currently involved in several lawsuits against insurance companies and I can advise you on your best course of action. Call today to learn more or to schedule a free consultation.

United Healthcare is currently facing a lawsuit from two of its customers who are suffering from limb loss. Those individuals asked for prosthetic limbs from the company, and the company issued a denial with very little information. The plaintiffs are seeking to make the lawsuit a class action lawsuit. They are asking the court to force the company to change its policies.

The plaintiffs both sought payment for microprocessor-controlled artificial limbs. Those limbs use microprocessors to power the limb instead of using the body. United denied those claims. In issuing its denial, the company alleged that the limb requested did not meet the minimum specifications of the member’s needs, which is all that the insurance policy will cover.

The lawsuit alleges that the company violated federal insurance claim procedures because it did not advise the plaintiffs of the reason their device did not meet the minimum specifications of the member’s functional needs, and it failed to identify the artificial device that did meet the minimum specification of the member’s needs.

If you are a customer of United Healthcare, and you have had a claim for a prosthetic limb denied, you should speak to an attorney. You may be eligible to join one of the ongoing lawsuits. Call me, Conal Doyle, amputation attorney, at 310-385-0567. I am currently working on several lawsuits against insurance companies and can provide you with a consultation on your case. Call to learn more.

Two people suffering from limb loss sued the Anthem health insurance company for its failure to pay for their artificial limbs. The company labeled the limbs as “investigational” and was sued as a result.

According to Anthem’s internal guidelines, the company will not cover any “investigational” services. The company uses seven criteria to determine if a service is investigational: 1. It has limited use on humans, which is not generally accepted as proven and effective procedures within the organized medical community; 2. It does not have final approval from the appropriate governmental regulatory body; 3. It is not supported by scientific evidence which permits conclusions concerning the effect of the service, drugs, or device on health outcomes; 4. It does not improve the health outcome of the patient treated; 5. It is not as beneficial as any established alternative; 6. The results outside the investigational setting cannot be demonstrated or duplicated; or 7. It is not generally approved or used by doctors in the medical community.

The plaintiffs claim that the criteria are erroneous when applied to some prosthetic devices. The documentation from the company cites studies to prove that the limbs are investigational, when the studies actually conclude that the devices provide significant benefits over other limbs.

The plaintiffs are asking the court to force the company to change its policies, as well as to compensate them for the limbs that were denied. If you have had a claim for a prosthesis denied by an insurance company, you should speak with an attorney. I can help. Call me, Conal Doyle, personal injury attorney at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation.