United Healthcare was sued late last year for failing to provide coverage for a prosthetic arm and hand for a 12-year-old boy named Logan. Logan does not have a right forearm and hand because of a congenital defect. He was insured under his mother’s health insurance plan with United Healthcare.
As Logan has grown, he required new prosthetic devices to fit his body. He uses both hands to perform normal functions of a 12-year-old boy, such as typing, eating, and even playing his trumpet. A prosthetist recommended that he be fitted with an i-limb quantum device with a High-Fidelity socket/interface. That type of device has articulating fingers that closely simulates a human hand and provides the six fundamental grips of a human hand. The hand allows users to perform many of the daily tasks that cannot be performed with other types of prostheses.
Logan’s mother requested that United Healthcare authorize coverage for the i-limb. United Healthcare denied the request for the device because it claimed the device exceeded the minimum specifications for his needs. Logan’s mother appealed and United denied coverage, claiming that the device has many features that exceeded Logan’s basic needs. Logan’s prosthetist then submitted a claim for a less expensive device, which United also denied the claim for.
Logan’s mother sued United Healthcare for denial of the prosthesis, along with other customers of United who have had their requests for artificial limbs denied. If you are a customer of United Healthcare or another insurance company and you believe the company wrongfully denied coverage for your prosthesis, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. I can help review your legal options. Call today to learn more or to schedule a free consultation.