Mother of 12-Year-Old Born without Arm Sues United Healthcare for Lack of Prosthesis Coverage

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.