Category: Amputation

Recently, two individuals who have suffered lower limb loss sued Anthem, a health insurance provider, for its failure to pay for lower limb prostheses under the insurance plan. The plaintiffs are seeking to certify their lawsuit as a class action.

In particular, the plaintiffs are suing Anthem because of its failure to provide microprocessor-controlled lower limb prostheses under the terms of the insurance plan. Anthem claims that it is not legally required to pay for those prostheses because under the terms of the policy, they are not medically necessary.

Anthem uses four criteria that must be met in order to pay for prostheses. First, the individual must have adequate cardiovascular reserve and cognitive learning ability to master the technology and to allow for faster than normal walking speed. Second, the individual must have demonstrated the ability to ambulate faster than the baseline rate. Third, the individual must have a documented need for daily long-distance ambulation at variable rates. Finally, the individual must have a demonstrated need for regular ambulation on uneven terrain or regular use of stairs.

The plaintiffs claim that all of the criteria that Anthem uses are erroneous. The plaintiffs claim that the first two criteria may allow a person with limb loss to walk faster, but that’s only one benefit of the device. They claim the third and fourth criteria are unreasonable.
The plaintiffs are asking the court to require Anthem to compensate them for microprocessor-controlled prostheses, as well as to change its policies going forward. If you or a loved one has had a claim denied by Anthem for a microprocessor-controlled prosthesis in California, call me, Conal Doyle, at 310-385-0567. I’m one of the attorneys involved in the lawsuit, and I can help. Call today to learn more about the lawsuit.

A lawsuit that was recently filed against Blue Shield of California, an insurance company, alleges that the insurance company wrongfully refuses to provide its customers with microprocessor-controlled foot prostheses. The lawsuit alleges that the company overlooks medical studies and other evidence in order to deny claims for the devices.

Blue Shield has written and implemented written positions on coverage on various devices, including microprocessor prostheses. Blue Shield has a medical policy called “Microprocessor-Controlled Prostheses for the Lower Limb”. The medical policy for Blue Shield states that microprocessor-controlled lower limbs are considered investigational.

However, the lawsuit alleges that studies have shown that microprocessor-controlled foot prostheses provide significant benefits over mechanical feet, and that Blue Shield’s medical policy ignores studies that show the benefits of microprocessor technology. The lawsuit claims that microprocessor devices respond to constant feedback from sensors, which allow for a more normal bend at the ankle when walking. This can reduce stumbles and falls and also can reduce pain.

Unfortunately, Blue Shield has continually denied most claims for microprocessor-controlled prostheses, which ultimately necessitated a lawsuit. If you have suffered limb loss and have had your claim for a prosthesis denied by Blue Shield, call me, Conal Doyle, Los Angeles class action attorney. I am involved in this lawsuit and can help explain your legal options. You can reach me at 310-385-0567.

A lawsuit was filed last fall in federal court in California, alleging that Anthem, a health insurance provider, wrongfully denied claims for microprocessor controlled protheses for customers who had suffered lower limb loss. The lawsuit claims that the denials were in violation of federal employment benefit laws.

Anthem has a coverage guideline called the Anthem Medical Policy on Microprocessor Controlled Lower Limb Prostheses, which the lawsuit alleges the company has used to deny most medical requests for the devices on the basis that they are not medically necessary. The company also claims that they are investigational devices, and therefore do not have to be covered under the policies.

According to the lawsuit, Anthem’s actions violate ERISA, which is a federal law that regulates employee benefits under employee benefit plans. The lawsuit is seeking to be certified as a class action and is seeking all people covered under Anthem plans whose requests for microprocessor-controlled knee or foot-ankle prostheses have been denied.

If you or a loved one has been a customer of Anthem in the past and have had your claim for a microprocessor controlled lower limb prothesis denied, call me, Conal Doyle, Los Angeles class action attorney at 310-385-0567. I am one of the attorneys who is involved in the lawsuit, and I can help walk you through your legal options. Call today to learn more or to schedule your free consultation.

At the end of 2017, two individuals who suffered limb loss sued United Healthcare in California, accusing the company of wrongfully denying claims for microprocessor prostheses. They are seeking to add additional plaintiffs and to certify the case as a class action lawsuit.

The lawsuit claims that United Healthcare has developed and implemented a Coverage Determination Guideline called “Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs”. The Guideline provides 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 pursuant to the Guideline, United Healthcare has systematically denied claims for prosthetic arms and legs without regard to the individual’s functional needs, and without bothering to assess or determine how the requested prosthetic device meets the minimum specifications of the individual’s needs. According to the lawsuit, as a result of United Healthcare’s policy, thousands of people with limb loss have had their claims for prosthetic arms and legs denied by United Healthcare without proper consideration and review, which is required under federal law.

The lawsuit is ongoing in California. The plaintiffs are seeking additional individuals who have suffered limb loss and who have had their claims for prostheses denied by United Healthcare to join the lawsuit. If you had insurance coverage from United Healthcare, and you believe your claim for a prosthesis was improperly denied, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. I am one of the attorneys involved in the lawsuit and can help ensure your legal rights are protected. Call today to learn more or to schedule a free consultation.

Two amputees sued Blue Shield of California over its coverage for prostheses. The plaintiffs allege that Blue Shield improperly failed to provide coverage for some prosthetic devices, as well as failed to maintain an adequate network of prosthetists.

The lawsuit is seeking to become a class action lawsuit. The lawsuit alleges that there are so many individuals affected by Blue Shield’s actions that a class action is appropriate. The lawsuit also alleges that the claims are all similar, that all members of the class will have their interests protected by the plaintiffs, and that a class action is the correct way to handle the case since it will help avoid inconsistent individual results, as well as to promote judicial economy.

A class action lawsuit can offer many benefits to litigants over many individual lawsuits over the same issue. If you have been affected by Blue Shield’s failure to cover some prostheses, or by its failure to maintain an adequate network of prosthetists, you may wish to join the class action lawsuit. Call Los Angeles amputation attorney Conal Doyle at 310-385-0567 to learn more about how to join the class action.

According to a lawsuit recently filed against Blue Shield of California, the company wrongfully failed to provide coverage for microprocessor-control prosthetic feet. The lawsuit alleges that the company deemed them as “investigational” and refused to provide coverage.

Microprocessor-controlled feet prostheses are artificial feet that respond to feedback from sensors to a computer in the feet. The computer can change resistance to downward motion and upward motion of a foot based on walking speed, incline, decline, and type of terrain. The computer can make adjustments in real time, which can decrease falls, increase stability, decrease discomfort and pain in the amputee, and improve ambulation.

According to the lawsuit, microprocessor-controlled feet are established and accepted by the medical community as standard, and they are routinely prescribed for people who meet appropriate medical criteria. Blue Shield has written policies about their coverage for prostheses. Their policies state that microprocessor-controlled feet are investigational. The lawsuit alleges that there have been numerous studies about the benefits of microprocessor-controlled feed, and that the medical policies ignore data that support the use of microprocessor technology.

If you have had coverage of a microprocessor-controlled prosthesis denied by Blue Shield of California, you may be eligible to join the lawsuit. Call Los Angeles personal injury attorney Conal Doyle at 310-385-0567. He can advise you on the best course of action to take. Call today to schedule your free consultation.

Two amputees recently filed a lawsuit against Blue Shield of California for failing to authorize payment for some types of prostheses and for underpaying out-of-network prosthetists for their services. The amputees are claiming that Blue Shield’s actions violated the Unfair Competition Law in California. They are seeking other amputees who have suffered financial losses as a result of Blue Shield’s practices to join the lawsuit.

The plaintiffs claim that Blue Shield has a policy of claiming that microprocessor-controlled foot prostheses are investigational, and therefore will not cover them. The health insurance policies issued by Blue Shield do not provide coverage for any health care services or devices the company deems to be investigational. The lawsuit claims that microprocessor technology has been used in prosthetics for decades and is standard in the industry and therefore is not investigational.

The lawsuit also alleges that the company allows its members to obtain services from in-network health care providers, and if a member chooses to work with an out-of-network provider, the member will normally pay a larger amount out-of-pocket for the health care services. The lawsuit alleges that implicit in the contract is the assumption that Blue Shield will develop a fully formed network of providers. However, Blue Shield has a very small network of prosthetists because of its low reimbursement rates, which results in most members being forced to seek the services of out-of-network providers.

The plaintiffs claim that Blue Shield’s policies are a violation of California’s business laws, and that the company should be forced to pay them compensation as well as to change their business practices. If you are an amputee and Blue Shield has not properly paid for your prosthesis, you have legal options. You may be able to join this lawsuit or seek compensation in other ways. 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.

Two individuals suffering from lower limb loss have sued Anthem on behalf of themselves and others over Anthem’s policy to deny coverage for microprocessor controlled lower limb prostheses. The plaintiffs are asking the court to provide financial compensation to them for their losses, as well as to order Anthem to cover those limbs going forward.

According to the lawsuit, Anthem has developed and used a coverage guideline called the Anthem Medical Policy on Microprocessor-Controlled Lower Limb Prostheses, Policy No. OR-PR.00003. Anthem uses that policy to deny claims for microprocessor controlled lower limb prostheses. Anthem claims that the microprocessor-controlled limbs are investigational and are not medically necessary.

The lawsuit alleges that microprocessor technology has been used in prostheses for decades and has long been standard in the industry. Microprocessors monitor a person’s gait using sensors, and then adjust resistance to the knee bending and straightening to accommodate the user’s walking speed and terrain. This can enhance stability and security for the user. Microprocessor-controlled devices are routinely prescribed for people who meet certain medical criteria.

Two people who suffered from lower limb loss and who had their claims for microprocessor-controlled limbs denied by Anthem have sued on behalf of themselves and others. If you have had a claim for coverage for a prosthetic device denied by Anthem, call me, Conal Doyle at 310-385-0567. I am one of the attorneys working on the lawsuit, and my firm can help. Call today to learn more or to schedule your free consultation on the case.

United Healthcare was sued late last year for failing to provide coverage for a prosthetic arm and hand for a 12-year-old boy named Logan. Logan does not have a right forearm and hand because of a congenital defect. He was insured under his mother’s health insurance plan with United Healthcare.

As Logan has grown, he required new prosthetic devices to fit his body. He uses both hands to perform normal functions of a 12-year-old boy, such as typing, eating, and even playing his trumpet. A prosthetist recommended that he be fitted with an i-limb quantum device with a High-Fidelity socket/interface. That type of device has articulating fingers that closely simulates a human hand and provides the six fundamental grips of a human hand. The hand allows users to perform many of the daily tasks that cannot be performed with other types of prostheses.

Logan’s mother requested that United Healthcare authorize coverage for the i-limb. United Healthcare denied the request for the device because it claimed the device exceeded the minimum specifications for his needs. Logan’s mother appealed and United denied coverage, claiming that the device has many features that exceeded Logan’s basic needs. Logan’s prosthetist then submitted a claim for a less expensive device, which United also denied the claim for.

Logan’s mother sued United Healthcare for denial of the prosthesis, along with other customers of United who have had their requests for artificial limbs denied. If you are a customer of United Healthcare or another insurance company and you believe the company wrongfully denied coverage for your prosthesis, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. I can help review your legal options. Call today to learn more or to schedule a free consultation.

According to a class action lawsuit filed late last year in California, Blue Shield of California (also known as California Physicians’ Service) has a practice of denying coverage for some lower limb devices. The company has also been accused of restricting payments for lower limb devices if the members seek services from an out-of-network provider.

Under the lawsuit, the company is accused of denying coverage for microprocessor-controlled foot prostheses for all of its customers. The company claims that microprocessor-controlled foot prostheses are investigational. Most insurance companies deny coverage for investigational medical treatments or devices.

The lawsuit also alleges that Blue Shield underpays all prosthetists for prosthetic leg components. As a result, the company has a very small network of in-network prosthetists. Customers of Blue Shield are therefore forced in most cases to use out-of-network prosthetists, which results in those customers paying a large portion of the cost of the devices.

If you or a loved one is a customer of Blue Shield of California and has been denied coverage for a microprocessor-controlled foot prosthesis, or if you have been forced to pay for a large portion of your prosthesis under Blue Shield’s insurance plan, call me, Conal Doyle, Los Angeles attorney at 310-385-0567. You may be eligible to join the class action lawsuit. Call today to learn more.