Late last year, three lawsuits were filed against major health insurance companies in California for their failure to pay for prosthetic limbs. The insurance companies that were sued are Anthem, Blue Shield, and United Healthcare. All three lawsuits were filed by amputees whose requests for prosthetic devices were denied. The lawsuits are ongoing and all are asking to be certified as class action lawsuits.
In all three lawsuits, the plaintiffs allege that the insurance companies failed to pay for their prosthetic limbs. The requested limbs were microprocessor-controlled limbs, which are prosthetic limbs that use sensors, computer chips, and a computer device to control the limb. The companies instead agreed to pay for only body-powered devices, which are generally less comfortable and less safe for the user.
In most cases, the companies labeled the devices as “investigational” and “not medically necessary”. Most insurance policies exclude devices and services that are either investigational or not medically necessary. However, the lawsuits allege that the devices have been in use for decades and are no longer investigational but are routinely prescribed. Also, the lawsuits cite numerous studies that show that the devices have many benefits and are medically necessary.
The lawsuits are seeking to be certified as class action lawsuits so that other plaintiffs can join if needed. If you or a loved one has had a claim for a prosthetic limb denied by an insurance company, you should speak with an attorney. Call me, Conal Doyle, Los Angeles amputation attorney, at 310-385-0567. I can help. Call today to learn more or to schedule your free consultation.