Category: Amputation

Late last year, two amputees sued United Healthcare on behalf of themselves and others. United Healthcare, a health insurance company, has refused to pay for myoelectric artificial arms for its customers. The customers claim that the company has acted in bad faith in its refusal to provide coverage.

According to the lawsuit, by the 1980s myoelectric arms were in use in rehabilitation centers around the world. They are commonplace today. Myoelectric arms have much better comfort, functionality, and appearance when compared with arms that are powered by the body. In addition, myoelectric arms are essential for the various activities of daily living, such as grasping objects and moving the hands with dexterity.

United has a guideline that it has used to deny claims for myoelectric arms. That guideline provides that benefits will only be provided for the prosthetic device that meets the minimum specifications for a customer’s needs. The lawsuit alleges that the company uses that guideline to systematically deny prosthesis devices without assessing or determining the individual’s functional needs.

The lawsuit against United is still ongoing, and several other lawsuits are also underway relating to insurance companies and their refusal to pay for prostheses. If you have had your claim for a prosthesis denied, you should speak with an attorney. Call me, Conal Doyle, Amputation Attorney, at 310-385-0567 to schedule a free consultation.

Two amputees have sued Blue Shield, a health insurance company, over its failure to maintain a well-developed network of prosthetists, among other allegations. The amputees claim that the company so poorly reimburses prosthetists that it has a very small network of them, which leads to the amputees being forced to pay large amounts out-of-pocket for prosthetic limbs.

Under Blue Shield’s guidelines, their health plans are designed for members to receive services from participating providers, or in-network providers. If members choose to use out-of-network providers, Blue Shield will pay a much smaller portion of the expense. The lawsuit alleges that implicit in the guidelines is a promise that Blue Shield will develop a fully formed network of providers, which will allow customers to receive the primary benefit of the insurance policy.

A recently filed lawsuit claims that Blue Shield has been unable to provide an adequate network of prosthetists because it offers very low reimbursement rates. Therefore, members are forced to seek the services of out-of-network providers, which leaves those members with large bills for their prostheses. The lawsuit is asking that, among other things, Blue Shield be required to reimburse members for their expenses of artificial limbs and to correct its practice of underpaying out-of-network prosthetists.

Several lawsuits are currently underway against insurance companies that have failed to properly provide coverage for prosthetic limbs. If you believe that your insurance company did not properly pay for your limb, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. You may be eligible to join one of the lawsuits. Call today to learn more or to schedule a consultation.

The mother of a 12-year-old son sued her health insurance company, United Healthcare, because of its failure to provide the proper prosthetic arm for her son. The company claimed that the device requested was not the most basic limb that would meet the boy’s needs.

The boy was born without a right forearm and hand. As he grows, he requires new prosthetic devices that will fit his body. His lifestyle requires the use of both hands to perform everyday functions such as typing, eating, and holding objects, such as his trumpet. A prosthetist recommended that he receive an i-limb quantum device with a High-Fidelity socket/interface. That type of device has articulating fingers and provides the six fundamental grips of the human hand. It allows users to perform many daily tasks that cannot be performed with other devices.

United denied coverage for the device, claiming that the artificial arm requested exceeds the benefit provided under their health plan. His doctor wrote a new prescription and his prosthetists put together a new detailed written order for a less expensive prosthesis, and his prosthetists provided documentation on why a basic, passive prosthesis did not meet his needs. United again denied the claim.

The boy’s mother sued, claiming that the company did not assess her son’s needs or the “minimum specifications” for his needs, and also did not consider what alternative prosthetic device met his needs. Instead, she alleges, the company simply made a statement that the device did not meet the minimum specifications for her son’s needs.

Several lawsuits are currently underway against insurance companies for their failure to provide prosthetic limbs for their customers. If you have requested an artificial limb from an insurance company and it refused your request, you should speak with an attorney. 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.

Late last year, six individuals suffering from limb loss sued three insurance companies, United Healthcare, Anthem, and Blue Shield. In the lawsuits, the plaintiffs claimed that the companies were wrongfully denying coverage for microprocessor-controlled limbs to their customers.

The plaintiffs are seeking to turn all three lawsuits into class action lawsuits. Class actions are often best for situations where several factors are present. First, there normally must be such a large number of class members that it would not be practical for them to sue individually. All of the plaintiffs must have common issues of law and fact. Any named plaintiffs must have claims that are typical of the claims of the other plaintiffs. The named plaintiffs must fairly and adequately represent and protect the interests of the members of the proposed class. The attorneys involved must be competent and experienced in litigating class action lawsuits. Finally, a class action must be superior to all other ways of adjudicating the case.

If you are suffering from limb loss and your insurance company denied your claim for a microprocessor-controlled prosthesis, call me, Conal Doyle, amputation attorney, at 310-385-0567. You may be eligible to join one of these lawsuits or other options may be available. Call today to learn more or to schedule your free consultation.

A mother of five sued the Anthem insurance company, claiming that the company wrongfully denied her claim for a prosthetic knee. She is seeking to turn the lawsuit into a class action on behalf of others whose prostheses were denied.

The plaintiff had her left leg amputated above the knee when she was 11 years old. She is married with five children and has insurance coverage through Anthem. In 2016, she was referred to a nationwide provider of prosthetic services, which determined that she needed a prosthetic leg with a microprocessor-controlled knee. The prosthetist sought authorization from Anthem for the leg.

Anthem denied the claim, stating that the microprocessor-controlled knee prosthesis was not medically necessary for the plaintiff, because she did not satisfy its criteria. She appealed twice. The company denied the claim, stating that in order to qualify, she must be able to walk faster than someone with a standard prosthesis. They also said she must need to walk over 400 yards a day, and the need to walk over uneven ground or to use stairs often. She also must be able to control a complex device. They found that she did not meet those requirements and therefore was not eligible for the device.

The woman sued the company, claiming it did not assess whether she met any valid criteria for receiving the device. She is asking that Anthem be required to change its policies, as well as to compensate her for the device.

There are currently several lawsuits underway involving insurance companies and their wrongful denials of coverage for microprocessor-controlled prostheses. If you have had your claim denied, call me, Conal Doyle, California amputation attorney, at 310-385-0567. I am working on these lawsuits and can help. Call today to learn more or to schedule a free consultation.

Late last year, some customers of Anthem, a medical insurance company, sued the company for its failure to provide certain types of prosthetic limbs. The company has denied coverage for microprocessor-controlled devices, which are prostheses which are controlled by a computer rather than simply powered by the human body.

Anthem denied coverage for those devices, claiming that they are investigational and not medically necessary for all indications. The documentation issued by the company acknowledges that there are studies which show the benefits provided by microprocessor-controlled foot-ankle prostheses.

The company’s documentation actually cites seven different studies in support of its conclusion that microprocessor devices are experimental and investigational. However, all of those studies concluded that microprocessor-controlled devices provided significant benefits over mechanical devices. None of the studies the company cited supports its conclusion that the devices are “experimental and/or investigational”. However, the company says that further study is needed to establish meaningful benefits of microprocessor devices over mechanical devices.

The plaintiffs are asking that Anthem be required to compensate them for their refusal to cover microprocessor prostheses, as well as cover those devices going forward. If you are a customer of Anthem and the company denied coverage for your prosthetic device, call me, Conal Doyle, personal injury attorney, at 310-385-0567. I am working on this lawsuit as well as others. Call today to learn more or to schedule a free consultation on your case.

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.

Two amputees who were covered by health insurance from United Healthcare have sued the company. The amputees claim that the company wrongfully refused to provide coverage for certain types of prostheses. The amputees are seeking to turn the lawsuit into a class action and to force the company to begin providing more coverage for prostheses.

The amputees are claiming that United Healthcare refuses to provide coverage for microprocessor-controlled prostheses. Those limbs are powered by microprocessors that react to stimuli in real time. Instead, the company provides only body powered limbs, which are much less expensive but pose more problems for most amputees.

The company claims that its policies provide only the most basic device to meet amputees’ needs. However, in their lawsuit the plaintiffs claim that the company does not properly assess or determine its customers’ functional needs and what prosthesis will meet their customers’ functional needs.

If you are a customer of United Healthcare or another health insurance company and you have had your claim for a microprocessor-controlled prosthetic limb denied, you should speak with an attorney. Call me, Conal Doyle, personal injury attorney, at 310-385-0567. I am one of the attorneys working on these lawsuits and I can help. Call today to learn more or to schedule a free consultation.

Blue Shield of California was recently sued for failing to provide certain types of artificial limbs to its members suffering from limb loss. Two of its members sued the company for its failure to properly compensate for artificial limbs.

The company’s written guidelines on coverage provided that “benefits are provided for Prostheses for Activities of Daily Living at the most cost-effective level of care that is consistent with professionally recognized standards of practice.” However, the company has refused to pay for microprocessor-controlled prostheses. It claims that the limbs are investigational, although there have been studies showing that the devices provide significant benefits over mechanical feet.

In addition, there is a significant amount of evidence that microprocessor-controlled limbs are effective. The limbs respond to constant feedback from sensors to the device’s computer, which changes the foot based on walking speed, incline, decline, and type of terrain. They allow for a more normal bend at the ankle when walking so that there is a reduction in toe drag, as well as better balance. This can help reduce falls and create better stability.

If you suffer from limb loss and your insurance company has refused to provide you with the proper limb, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. I am currently working on three lawsuits against insurance companies and would be happy to talk to you. Call today to learn more or to schedule a free consultation.

United Healthcare was sued late last year by two of its customers who suffer from limb loss. They claim that United failed to properly pay for the prosthetic limbs they needed. They are suing the company on behalf of themselves and other amputees whose claims for prostheses were denied by United Healthcare.

One of the issues in the lawsuit is United’s written guidelines for the coverage of prosthetic arm and leg devices. The guidelines provide 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” of the member’s needs.”

The lawsuit claims that United has used its written policy to systematically deny claims for prosthetic limb devices without assessing or determining the customer’s functional needs, without assessing or determining whether the requested device meets the “minimum specifications” of the claimant’s needs, and without ascertaining or identifying an artificial device that would meet the minimum. In particular, with regards to one of the plaintiffs, the lawsuit claims that United did not look at his functional needs, the minimum specifications for his needs, whether the prosthetist was wrong about his needs and the minimum specifications for those needs, and what alternative device would meet his needs.

The lawsuit against United Healthcare is currently ongoing. In addition, there are other lawsuits against major insurers who failed to pay for some types of prostheses. If your claim for a prosthetic limb was 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.