United Healthcare has been sued for refusing to provide an amputee with a complex prosthetic limb. The insurance company claimed that the amputee was only able to receive the “most basic leg” that met his needs. He sued the company and is seeking to have the lawsuit certified as a class action.
The man underwent a below the knee amputation of his left leg that resulted from severe injuries he suffered in an accident in 2017. When the accident occurred, the man was in his mid-20s and was working as an account manager. He had an active lifestyle that included mountain biking, jogging and hiking.
He was referred by his doctor to a team of prosthetists for a below-the-knee prosthetic device. Because of his active lifestyle, the prosthetists recommended a below-the-knee device that included a Trans-tibial High-Fidelity Interface (socket) prosthesis. The insurance company denied the request on the basis that the device may not be the “most basic leg” that meets his needs. The company said that the man’s insurance plan will only cover the most basic artificial leg that meets his needs.
The man appealed, and the company denied his appeal. He requested that United reconsider its denial of his appeal, and the company denied his request. He then sued United. According to this lawsuit, United did not properly determine his needs, the minimum specifications for his needs, whether the man’s prosthetists was wrong about his needs, and what alternative device met his needs. Instead, the company simply issued a denial with a statement that the device was not the most basic for him.
If you are an amputee and your insurance company has denied coverage for your prosthesis, you should speak with an attorney. Call me, Conal Doyle, amputation attorney. I’m currently working on several lawsuits against insurance companies that have refused to cover prosthetic devices. Call me today at 310-385-0567 to learn more or to schedule a free consultation.