United Healthcare was sued late last year by two of its customers who suffer from limb loss. They claim that United failed to properly pay for the prosthetic limbs they needed. They are suing the company on behalf of themselves and other amputees whose claims for prostheses were denied by United Healthcare.
One of the issues in the lawsuit is United’s written guidelines for the coverage of prosthetic arm and leg devices. The guidelines provide 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” of the member’s needs.”
The lawsuit claims that United has used its written policy to systematically deny claims for prosthetic limb devices without assessing or determining the customer’s functional needs, without assessing or determining whether the requested device meets the “minimum specifications” of the claimant’s needs, and without ascertaining or identifying an artificial device that would meet the minimum. In particular, with regards to one of the plaintiffs, the lawsuit claims that United did not look at his functional needs, the minimum specifications for his needs, whether the prosthetist was wrong about his needs and the minimum specifications for those needs, and what alternative device would meet his needs.
The lawsuit against United Healthcare is currently ongoing. In addition, there are other lawsuits against major insurers who failed to pay for some types of prostheses. If your claim for a prosthetic limb was denied by your insurance company, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation.