Category: Amputation

A lawsuit was recently filed against Anthem, a health insurance company that operates in several states. The lawsuit was filed by two customers of Anthem who have suffered from limb loss. The lawsuit alleges that Anthem did not properly cover the customers’ artificial limbs.

The lawsuit alleges specifically that Anthem refuses to pay for microprocessor-controlled knees. Microprocessor-controlled knees feature a microprocessor, sensors, software, a resistance system, and a battery. The knee also has internal fluid. The microprocessor monitors each phase of a person’s gait cycle using a series of sensors, which detect and monitor changes in the environment. Based on the feedback, the microprocessor adjusts resistance to the knee, which enhances stability and security, decreases the number of stumbles and falls, and provides improved ambulation.

The lawsuit alleges that microprocessor-controlled knees are now considered standard in the industry. They are used primarily for normal activities of daily living and are necessary for amputees of almost every demographic. However, Anthem has ignored medical studies and claims that the knees are considered investigational and not medically necessary.

Lawsuits are ongoing against Anthem as well as other insurance companies which have failed to provide their customers with the proper artificial limbs. If you suffer from limb loss and your insurance company has refused to pay for your artificial limb, 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.

Late last year, three insurance companies operating in California were sued for their failure to cover certain types of artificial limbs. The three insurance companies are Blue Shield, Anthem, and United Healthcare. According to the lawsuits, the three companies all have improperly denied claims for microprocessor-controlled lower limbs for customers who are suffering from limb loss.

The lawsuits are all different, but all allege that the insurance companies regularly deny coverage for some artificial limbs for their customers. The insurance companies often refuse to pay for microprocessor-controlled limbs, and instead only pay for body-powered artificial limbs. Microprocessor-controlled limbs use computer chips to adjust settings for their users based on feedback from the limb. Those limbs are typically more expensive, but provide a number of huge benefits for the users.

The insurance companies have been denying coverage for the limbs for several reasons. They claim that the limbs are investigational, not medically necessary, or not the most basic limb that will meet the user’s needs. One company was sued for failing to maintain an appropriate network of prosthetists, resulting in huge fees for its customers suffering from limb loss.

Call me, Conal Doyle, Los Angeles personal injury attorney at 310-385-0567 if you have suffered from limb loss and your insurance company refused to pay for the appropriate limb for you. My team can help.

A California man has sued United Healthcare on behalf of himself and other individuals suffering from limb loss, for its failure to provide him with the proper artificial limb. He claims that United improperly failed to assess his needs or provide any reasons for denying him with the leg.

The man suffered severe injuries in an accident in 2017. As a result, he had a below-the-knee amputation of his left leg. At the time of the accident, he had insurance through United due to a policy issued to his wife’s employer. He maintained an active lifestyle that included jogging, hiking, and mountain biking. He was in his 20s.

His doctor referred him to a prosthetist for a below-the-knee prosthesis. Because of his active lifestyle, the prosthetist recommended that he be outfitted with a below-the-knee device that included a trans-tibial high-fidelity interface.

United Healthcare denied the request for his device because it “may not be the most basic leg” that meets his needs. United says that his health plan only covers the most basic artificial leg that meets his needs. The man appealed twice, but the company denied his appeal.

His lawsuit claims that United acted wrongfully and did not properly assess or determine his functional needs, the minimum specifications for his functional needs, whether his prosthetist was wrong about his needs and the minimum specifications for his needs, and what alternative prosthesis met his needs. The lawsuit also claims that United failed to provide any facts or reasons supporting his denials and instead simply claimed that the requested device was not the most basic for him.

If you are an amputee and you have had your claim for a prosthesis denied by an insurance company, you should speak with an attorney. Call me, Conal Doyle, amputation attorney, at 310-385-0567. I am currently working on several lawsuits against health insurance companies which you may be eligible to join. Call today to learn more.

The Anthem insurance company has been sued by two individuals who have suffered from limb loss. The plaintiffs are claiming that the company failed to properly pay for their prosthetic limbs. The plaintiffs are seeking other individuals with similar claims against the company in order to certify the case as a class action lawsuit.

The lawsuit claims that the company denies requests for microprocessor-controlled knee prostheses based on erroneous criteria. The lawsuit claims that Anthem deems those prostheses as not medically necessary unless all four of the following criteria are met:

1. The individual has adequate cardiovascular reserve and cognitive learning ability to master the higher level technology and to allow for faster than normal walking speed; and
2. The individual has demonstrated the ability to ambulate faster than his or her baseline rate using a standard swing and stance lower extremity prosthesis; and
3. The individual has a documented need for daily long distance ambulation at variable rates; and
4. The individual has a demonstrated need for regular ambulation on uneven terrain or regular use of stairs.

According to the lawsuit, the four criteria are erroneous and unreasonable. The lawsuit claims that microprocessor-controlled knees are intended to help with activities of daily living, which are not taken into account in the company’s criteria.

If you have suffered from lower limb loss and your insurance company has refused to properly pay for a prosthesis, you should speak with an attorney. Call me, Conal Doyle, California amputation attorney at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation.

Last year, Blue Shield of California was sued for violating California’s Business and Professions Code section 17200, also known as the Unfair Competition Law. The lawsuit arose from the company’s failure to provide some of its customers suffering from limb loss with certain types of protheses.

According to the lawsuit, Blue Shield has repeatedly failed to provide coverage for microprocessor-controlled prostheses. The lawsuit claims that the company breached California’s Unfair Competition Law in several ways: (1) the company had a systematic and repeated breach of the terms of its insurance policies by refusing to provide payment for microprocessor-controlled prostheses because they were “investigational”; (2) the company breached its policies in bad faith by ignoring scientific evidence that microprocessor-controlled foot prostheses are not “investigational”; (3) the company breached its policies by underpaying out-of-network prosthetists for prosthetic legs; (4) the company performed other unfair acts of which the plaintiffs are unaware.

If you have had your claim for a prosthetic limb denied by Blue Shield or another insurance company, call me, Conal Doyle, at 310-385-0567. I am working on several class action lawsuits against insurance companies for their failures to pay for prosthetic limbs. Call to learn more or to schedule a free consultation on your case.

Last year, United Healthcare was sued by two of its customers suffering from limb loss. The company refused to pay for microprocessor-controlled prosthetic limbs. The company refuses coverage based on its internal policies.

According to United Healthcare’s policies, if more than one prosthetic device can meet a customer’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications for the member’s needs. For many amputees, a microprocessor-controlled prosthesis is the best device that will meet their needs, but a body-powered prosthesis is much cheaper.

United Healthcare’s position is that if more than one prosthetic device is available that will meet a customer’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications for the customer’s needs. The lawsuit alleges that United Healthcare has used the provision to deny prosthetic devices without assessing the needs of the customer, without determining how the required device meets the minimum specifications of the customer’s needs, and without identifying an alternative prosthetic device that does meet the minimum specifications of the claimant’s needs.

If you are covered by an insurance policy from Anthem, Blue Shield, or United Healthcare, and you have had a claim for a prosthetic limb denied, call me, Conal Doyle, insurance bad faith attorney at 310-385-0567. My team is actively working on these cases and we may be able to help. Call today to learn more or to schedule a free consultation on your case.

Two members of Blue Shield of California’s insurance plan have sued the company. In their lawsuit, among other claims, they claim that the company fails to properly compensate out-of-network prosthetists for leg components. This has resulted in some individuals suffering from limb loss in being forced to pay out of pocket for some prostheses.

According to the lawsuit, Blue Shield of California has implicitly promised to its customers that it would provide an adequate network of prosthetists from which its customers could choose. However, the lawsuit claims that prosthetists are not properly paid for prosthetic leg components. This has resulted in a small network of prosthetists who are contracted with Blue Shield. As a result, many customers are unable to work with an in-network prosthetist, and are forced to seek the services of an out-of-network prosthetist.

The lawsuit alleges that Blue Shield has such low contracted rates that the vast majority of prosthetists refuse to enter into a contract with the company. One of the plaintiffs was forced to pay almost $20,000 out of pocket for his new prosthetic device. The lawsuit is asking that the company reimburse customers who had to pay out-of-pocket for prostheses, as well as change its policies going forward.

If you are suffering from limb loss and your insurance company has improperly reimbursed you for a prosthesis, you should speak with an attorney. Call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. We can help. Call today to learn more or to schedule a free consultation.

Last year, three large insurers in California were sued by customers who suffered from limb loss. The three insurers are Anthem, Blue Shield, and United Healthcare. The insurers were all sued because of their failure to provide their customers with microprocessor-controlled lower limb prostheses.

Microprocessor-controlled lower limbs are prostheses that use computer components to power artificial knees and feet in these devices. The devices more closely resemble the movements or real legs with feet and knee components that can react in real time to stimuli and can adjust to terrain and minimize stumbles and falls.

Although the three lawsuits were different, all three companies refused to provide the limbs because they claimed they are investigational or not medically necessary. However, the companies’ positions ignore the fact that microprocessor technology has been used in prostheses for decades and has long been standard in the industry. The companies’ reluctance to pay for the devices stems from their expense – microprocessor limbs are more expensive than other types of limbs.

All three lawsuits are actively seeking plaintiffs who have had their claims for prostheses denied by the insurance companies. If you have suffered from limb loss and have had your claim for a microprocessor limb denied by an insurance company, call me, Conal Doyle, 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.

Anthem, the health insurance company, was sued last year on the basis of its failure to provide coverage for microprocessor-controlled foot-ankle prostheses. The lawsuit was initiated by two Anthem customers suffering from limb loss whose limbs were denied on the basis that the prostheses were “not medically necessary for all indications.”

One of the Anthem customers who sued the company lost his leg in an accident. At the time of the accident, he had an active lifestyle that included hiking, jogging, and mountain biking. Prosthetists recommended that he receive a below-the-knee device that included a Trans-tibial High-Fidelity Interface prosthesis.

The company denied the claim, stating that the device “may not be the most basic leg” that met his needs. In its denial, the company said that his insurance policy only covers the most basic artificial leg that will meet his needs, and that the leg that was requested was not the most basic. The plaintiff appealed the decision a couple of times, but was denied. The company failed to provide any facts or reasons supporting the denial and instead simply alleged that the requested prosthesis was not the most basic for the plaintiff.

If you have suffered limb loss and your insurance company has refused to provide you with a prosthesis that meets your needs, you should speak with an attorney. Call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am working on several lawsuits against companies which have refused to provide coverage for some prostheses. Call today to learn more or to schedule a free consultation.

Late last year, the Anthem insurance company was sued for failing to pay for microprocessor-controlled foot-ankle prostheses for its customers suffering from limb loss. Microprocessor-controlled prostheses use technology to simulate the movements of a normal foot and ankle. The device responds to constant feedback from sensors to the microprocessor and makes adjustments in real time.

Microprocessor-controlled lower limbs are commonly accepted by the medical community at large as “standard” prostheses. They are routinely prescribed for people meeting the appropriate medical criteria. Anthem has developed medical policies that tells whether certain medical treatments are medically necessary and/or investigational. Anthem’s policies are used to deny requests for microprocessor-controlled lower limb prostheses.

Anthem claims that microprocessor-controlled lower limb prostheses are investigational and not medically necessary. However, the company accepts that there are studies showing the benefits created by microprocessor-controlled foot-ankle prostheses. The company has actually cited seven studies in support of its conclusion that microprocessor ankle-feet are “experimental and investigational”. However, every one of those studies concluded that microprocessor ankle-feet provided significant benefits over mechanical ankle-feet.

The lawsuit is ongoing and is in the early stages. If you are a customer of Anthem who suffers from limb loss and had your claim for a prosthesis denied, call me, Conal Doyle, California amputation attorney at 310-385-0567. I am working on the lawsuit and can help. Call today to learn more or to schedule a free consultation.