A lawsuit that was filed last year alleges that Blue Shield, a health insurance company, has wrongfully denied claims for some types of prosthetic feet. The lawsuit was filed by two customers of Blue Shield whose claims for prosthetic limbs have been denied. The lawsuit is ongoing.
The lawsuit claims that Blue Shield routinely denies requests for microprocessor-controlled prosthetic feet. Microprocessor-controlled feet are prosthetic feet that are powered by microprocessors instead of by the human body. The company has developed and implemented a written medical policy called “Microprocessor-Controlled Prostheses for the Lower Limb”. The policy says that Blue Shield considers microprocessor-controlled feet as investigational.
In its documentation, Blue Shield references studies on microprocessor-controlled feet. The studies concluded that microprocessor-controlled foot prostheses provide significant benefits over mechanical feet, yet according to the lawsuit Blue Shield ignores that aspect of the studies. The lawsuit also claims that there are numerous other studies that support the effectiveness of microprocessor foot-ankle technology.
Prosthetics which are powered by microprocessors are significantly more expensive than those powered by the body. Therefore, insurance companies are reluctant to cover them. If you believe your claim for a microprocessor prosthesis was incorrectly denied by an 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.