Two individuals who have lost limbs and were insured by United Healthcare sued the insurance company. The plaintiffs claimed that the company has been issuing blanket denials on certain types of prosthetic devices without investigating the situation.
United has a guideline that it uses to determine coverage for prosthetic devices. The guideline states that “If more than one prosthetic device can meet the member’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications for the member’s needs.”
According to the lawsuit, the company uses that provision to systematically deny coverage for prosthetic arm and leg devices without properly assessing or determining the member’s functional needs, without properly assessing or determining how the requested prosthetic device meets the “minimum specifications” of the individual’s needs, and without ascertaining or identifying an alternative prosthetic device that meets the “minimum specifications” of the individual’s needs.
Two individuals sued the company, claiming that it refused to provide a microprocessor-controlled limb without even assessing their needs, the minimum specifications for their needs, and what device met their needs. Instead, the company simply notified the customers that the devices requested were not the most basic and issued denials without any investigation.
If you were a customer of United and the company refused to pay for your prosthesis, you should speak with an attorney. Call me, Conal Doyle, personal injury attorney, at 310-385-0567. I am currently working on several lawsuits against health insurance companies that are refusing to provide coverage for certain limbs. Call today to learn more or to schedule a free consultation.