A lawsuit is currently underway against United Healthcare for its failure to pay for prosthetic limbs for some of its customers. One of the customers who is currently involved in the lawsuit is a 12-year-old-boy suffering from limb loss. The plaintiffs are seeking to turn the lawsuit into a class action.
The boy was covered under his mother’s insurance plan issued by United Healthcare. He suffers from a congenitally-acquired absence of the right forearm. As he has grown, he has required new prosthetic devices to fit his body. His prosthetic forearm and hand help him to perform everyday functions such as eating, typing, hygiene, playing the trumpet, and other tasks.
A prosthetist recommended an i-limb quantum device with a High-Fidelity socket/interface. This device is powered by microprocessors. It has articulating fingers that simulate a human hand by providing the six fundamental grips of the human hand. It lets users use a keyboard, cut food, and perform many other tasks of daily living that cannot be performed with a body powered device.
United Healthcare denied the request for the device, stating the it exceeded the minimum specifications for the boy’s needs. His mother appealed, and the appeal was denied. The prosthetists put together a new detailed order for a less expensive prosthesis, which United again denied. The boy’s mother sued, alleging that the company failed to provide any reasons or facts supporting the denials, but instead issued a blanket statement that the device was not covered.
If you have had a claim for a prosthetic device denied by an insurance company, call me, Conal Doyle, Los Angeles amputation attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation on your case.