A class action lawsuit was filed late last summer against Anthem, one of the largest health insurance companies in the U.S. Anthem was accused of denying coverage for some lower limb prostheses because they were determined to be “not medically necessary”. The lawsuit is seeking damages for the amputees as well as an injunction against the company, as well as attorney’s fees.
The lawsuit alleges that Anthem has developed a coverage guideline that it uses to deny claims for microprocessor controlled lower limb prostheses. According to the lawsuit, improvements in technology have allowed prostheses manufacturers to use microprocessors to power artificial knees and foot-ankle devices. Microprocessors controlled devices use technology to simulate the movements of a normal knee or a normal foot and ankle. These devices are considered as standard now and are routinely prescribed.
Anthem’s policy is that microprocessor controlled lower limb prostheses are not medically necessary. Anthem also labels the devices as “investigational”. According to the lawsuit, studies have concluded that microprocessor controlled lower limbs provide significant benefits and therefore are medically necessary. The lawsuit also alleges that there is more than sufficient evidence of the effectiveness of the devices, and that they therefore are not investigational.
If you are an amputee and you have been denied coverage for a lower limb prosthetic by Anthem, call me, Conal Doyle, California Amputation Attorney at 310-385-0567. I can help you join the class action lawsuit or help you to find other ways to be compensated for your device. Call today to learn more.