Last year, United Healthcare was sued by two of its customers suffering from limb loss. The company refused to pay for microprocessor-controlled prosthetic limbs. The company refuses coverage based on its internal policies.
According to United Healthcare’s policies, if more than one prosthetic device can meet a customer’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications for the member’s needs. For many amputees, a microprocessor-controlled prosthesis is the best device that will meet their needs, but a body-powered prosthesis is much cheaper.
United Healthcare’s position is that if more than one prosthetic device is available that will meet a customer’s functional needs, benefits are only available for the prosthetic device that meets the minimum specifications for the customer’s needs. The lawsuit alleges that United Healthcare has used the provision to deny prosthetic devices without assessing the needs of the customer, without determining how the required device meets the minimum specifications of the customer’s needs, and without identifying an alternative prosthetic device that does meet the minimum specifications of the claimant’s needs.
If you are covered by an insurance policy from Anthem, Blue Shield, or United Healthcare, and you have had a claim for a prosthetic limb denied, call me, Conal Doyle, insurance bad faith attorney at 310-385-0567. My team is actively working on these cases and we may be able to help. Call today to learn more or to schedule a free consultation on your case.