Category: Amputation

Blue Shield, the health insurance company, was sued late last year over its policies for coverage of prosthetic limbs. Two amputees sued the company, claiming that it has been wrongfully denying payments for some prostheses for its customers. The plaintiffs are asking that the court certify the lawsuit as a class action.

According to the lawsuit, Blue Shield is failing to reimburse customers for their lower limb prostheses that are a certain type, microprocessor-controlled. Those prostheses cost more than other, simpler prostheses, and many insurance companies try to avoid covering their cost.

Blue Shield has developed and implemented a written Medical Policy called “Microprocessor-Controlled Prostheses for the Lower Limb”. It states that microprocessor-controlled or powered foot is considered investigational. However, the plaintiffs claim that Blue Shield misstates the impact of some studies of the benefits of this device and ignores other studies that support microprocessor foot-ankle technology.

The lawsuit claims that there is more than sufficient evidence of the effectiveness of microprocessor-controlled limbs. They respond to feedback and allow for a more normal bend at the ankle. They normally reduce pain and reduce stumbles and falls.

If you are a customer of Blue Shield and the company failed to pay for your prosthetic device, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I’m working on several of these lawsuits and am happy to speak with you. Call today to learn more or to schedule a free consultation on your case.

Anthem, a health insurance company, has been sued by two of its members who are suffering from limb loss. They claim that Anthem failed to properly pay their claims for prosthetic limbs. They are seeking to turn their lawsuit into a class action lawsuit so that others who were similarly affected can join the lawsuit. They are also asking that the company be required to change its policies going forward, and to compensate them for their artificial limbs.

Anthem has labeled certain types of prostheses as “investigational” in some of its claim denials. The limbs they label as investigational are microprocessor-controlled limbs, which are artificial limbs that are controlled by computer chips and sensors, rather than being powered by the human body. According to the lawsuit, microprocessor limbs are now standard in the industry and are routinely prescribed.

Under Anthem’s insurance plans, “investigational” services are not covered. The company defines “investigational” services as services: 1) that have progressed to limited use on humans; or 2) that do not have final approval from the government; or 3) that are not supported by scientific evidence; or 4) that do not improve the health outcome of the patient; or 5) that are not as beneficial as an alternative; or 6) whose results cannot be demonstrated or duplicated; or 6) that are not generally approved or used by doctors in the medical community. The lawsuit alleges that microprocessor devices are not investigational and do not meet any of the criteria in the policies.

If you are an amputee and you have had a claim denied by Anthem, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. My team can help. You may be eligible to join the lawsuit. Call to learn more about your legal rights.

Two individuals suffering from limb loss have sued United Healthcare, claiming that the company’s policies with respect to coverage for artificial limbs are in violation of the law. The lawsuit is asking that United be required to change its policies going forward with respect to coverage for artificial limbs.

The company is accused of issuing blanket denials for some types of prosthetic limbs without property assessing the individual’s needs, what device will best meet those needs, and which alternative prosthetic devices will meet the individual’s needs. The lawsuit is asking that the company be required to change its policies going forward.

Specifically, the lawsuit is asking the court to order United Healthcare to take several actions. First, the plaintiffs are asking the court to order the company to revise its language and claims procedures with regard to payment for prosthetic limbs. They are asking that the company be required to reevaluate the Plaintiffs’ claims under the revised procedures. They are also asking that the company account for any profits it made as a result of improperly denying claims.

If you are an amputee and a customer of United Healthcare, and your claim for a prosthetic limb has been denied, you may be eligible to join the ongoing lawsuit against the company. Call me, Conal Doyle, California personal injury attorney, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation on your case.

Two amputees sued Blue Shield of California, a health insurance company. The amputees claim that Blue Shield has been acting in bad faith in its practices in compensating members for their artificial limbs. The lawsuit is seeking to be certified as a class action, meaning that others who have been similarly affected by Blue Shield will be eligible to join the lawsuit.

Specifically, the amputees have two claims. First, they claim that the company wrongfully denies all claims for microprocessor-controlled foot prostheses. The company claims that the limbs are investigational. The lawsuit alleges that studies show that the limbs are not investigational and that they provide significant benefits over mechanical feet. The second claim is that the company failed to develop a network of prosthetists, resulting in many amputees being forced to use out-of-network prosthetists, resulting in large out-of-pocket expenses to them.

The lawsuit is seeking certification of two classes. The first is all people covered under Blue Shield of California whose requests for microprocessor-controlled foot prostheses have been or will be denied as “investigational”. The second is all people covered under Blue Shield of California whose requests for prosthetic limbs were paid to out-of-network providers.

If you believe that your claim for a prosthetic limb was incorrectly handled by Blue Shield of California, call me, Conal Doyle, California amputation attorney, at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation on your case.

A married mother of five sued Anthem, a health insurance company, for its failure to pay for her prosthetic leg. She claims that the company is acting in bad faith in denying her request.

The woman was diagnosed with a cancerous tumor in her left leg when she was 11. Her leg was amputated above the knee, and she was fitted with a prosthesis. She now has five children. In 2016, she was referred to a prosthetist who determined she needed a prosthetic leg with a microprocessor-controlled knee. The prosthetist sought authorization from Anthem for the device.

Anthem denied coverage, stating that the microprocessor-controlled knee prosthesis was not “medically necessary”. The woman appealed the decision. A month later, Anthem denied the request, stating that she did not meet the criteria for a microprocessor device because she did not need to walk more than 400 yards a day at different speeds. She did not need to walk over uneven ground or use stairs outside of her home or workplace, and could not control a complex device. The company found that she did not meet its criteria.

The lawsuit alleges that Anthem’s policy was to deny coverage for microprocessor-controlled knee prostheses as not medically necessary when the requests did not meet all of the company’s erroneous criteria. The lawsuit also alleges that the company failed to assess whether the woman met any valid individual medical criteria for receiving the device.

The lawsuit is seeking to be certified as a class action lawsuit. If you had a request for a prosthetic device denied by Anthem or another insurance company, call me, Conal Doyle, at 310-385-0567. I can help. Call today to learn more or to schedule a free consultation on your case.

Two individuals suffering from limb loss sued Blue Shield, the health insurance company, last year. The amputees are claiming that Blue Shield violated the terms of its health insurance policies in two ways. First, the company categorically denies all requests for some types of lower limb prostheses. The lawsuit also alleges that the company does not maintain an appropriate network of prosthetists, which forces many customers to seek services from out-of-network providers. The lawsuit is asking that the company be required to change its policies, as well as to reimburse the plaintiffs for their expenses.

The plaintiffs are seeking to turn the lawsuit into a class action lawsuit, so that other individuals who have been similarly affected can join the lawsuit. The lawsuit is asking that two classes of plaintiffs be certified: (1) all people covered by Blue Shield policies whose policies for microprocessor-controlled foot prostheses have been or will be denied, and (2) all people covered by Blue Shield policies whose requests for prostheses were paid to out-of-network providers.

The lawsuit claims that it should be certified as a class action because there are large numbers of potential plaintiffs, the plaintiffs are ascertainable, common questions of law and fact exist as to all members of the classes, the plaintiff’s claims are typical of the members of the classes, and the plaintiffs will fairly and adequately protect the interests of the members. If the lawsuit is certified as a class action lawsuit, that will all amputees who were similarly affected by Blue Shield’s policies to join in on one lawsuit, instead of suing the company individually.

If you believe that you potentially have a claim against Blue Shield for its failure to pay for your prosthetic device, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation.

Late last year, three lawsuits were filed against major health insurance companies in California for their failure to pay for prosthetic limbs. The insurance companies that were sued are Anthem, Blue Shield, and United Healthcare. All three lawsuits were filed by amputees whose requests for prosthetic devices were denied. The lawsuits are ongoing and all are asking to be certified as class action lawsuits.

In all three lawsuits, the plaintiffs allege that the insurance companies failed to pay for their prosthetic limbs. The requested limbs were microprocessor-controlled limbs, which are prosthetic limbs that use sensors, computer chips, and a computer device to control the limb. The companies instead agreed to pay for only body-powered devices, which are generally less comfortable and less safe for the user.

In most cases, the companies labeled the devices as “investigational” and “not medically necessary”. Most insurance policies exclude devices and services that are either investigational or not medically necessary. However, the lawsuits allege that the devices have been in use for decades and are no longer investigational but are routinely prescribed. Also, the lawsuits cite numerous studies that show that the devices have many benefits and are medically necessary.

The lawsuits are seeking to be certified as class action lawsuits so that other plaintiffs can join if needed. If you or a loved one has had a claim for a prosthetic limb denied by an insurance company, you should speak with an attorney. Call me, Conal Doyle, Los Angeles amputation attorney, at 310-385-0567. I can help. Call today to learn more or to schedule your free consultation.

In December of 2017, United Healthcare, the health insurance company, was sued by two amputees. The lawsuit alleges that the company violated its own policies by refusing requests for some prosthetic devices without an investigation into the requested device. The amputees are asking that the lawsuit be certified as a class action and that the company be forced to change its policies going forward.

According to the terms of the insurance contract, “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.” The lawsuit alleges that United uses this provision to systematically deny prosthetic arm and leg devices without assessing or determining the member’s functional needs, without properly assessing or determining how the requested prosthetic device meets the minimum specifications of the member’s needs, and without identifying an alternative prosthetic device that does meet the minimum specifications of the member’s needs.

Both plaintiffs in the lawsuit requested an artificial limb that was powered by microprocessors. Both plaintiffs were active and needed a device beyond a basic limb. In both cases, the insurance company denied the request without any reasoning or evaluation of the situation.

The plaintiffs are asking that United reimburse them for their prosthetic limbs, and that going forward the company be required to change its policies about coverage for artificial limbs. If you are suffering from limb loss, and your insurance company has denied your request for an artificial limb, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation on your case.

Anthem, the health insurance company, was sued last year by two individuals suffering from limb loss. They sued Anthem for its failure to provide microprocessor-controlled prosthetic devices, which are devices controlled by computer chips. Instead, the company will only cover body-powered devices. The lawsuit is seeking to be certified as a class action lawsuit so that others who are similarly affected can join.

According to the lawsuit, Anthem incorrectly denies requests for microprocessor knee prostheses. Anthem has deemed requests for those devices as “not medically necessary” unless the following criteria are met:

• The individual has adequate cardiovascular reserve and cognitive learning ability to master the higher level technology and to allow for faster than normal walking speed; and
• The individual has demonstrated the ability to ambulate faster than their baseline rate using a standard swing and stance lower extremity prosthesis; and
• The individual has a documented need for daily long distance ambulation at variable rates; and
• The individual has a demonstrated need for regular ambulation on uneven terrain or regular use on stairs (excluding home and work).

The lawsuit alleges that these four criteria are erroneous. Microprocessor legs are primarily used to accomplish the normal activities of daily living, not to engage in athletic endeavors. The lawsuit is asking that Anthem reimburse the plaintiffs for their artificial limbs, as well as to change its plans going forward to cover those devices.

If you are a customer of Anthem or another insurance company, and your request for a prosthesis has been denied, you should speak with an attorney. Call me, Conal Doyle, Los Angeles personal injury attorney, at 310-385-0567. My team can help. Call today to learn more or to schedule a free consultation.

Three major insurance companies, Anthem, United, and Blue Shield, have recently been sued for their failure to pay for prosthetic limbs for their customers. Each of the lawsuits was filed late last year, and all three lawsuits are seeking to be certified as a class action lawsuit.

The lawsuits, while all slightly different, all claim that the insurance company wrongfully refused to pay for a microprocessor-controlled prosthetic limb. Microprocessor-controlled prostheses use computers and sensors and can react in real-time to help the user with stability, dexterity, and many other benefits. The other alternative is body-powered limbs, which are normally more uncomfortable, less safe, and less functional.

Generally, insurance companies have been reluctant to pay for microprocessor-controlled limbs because of the high expense. They often claim that other limbs are all that are needed and are all that the policies cover. They may label microprocessor-controlled limbs as “investigational” or “not medically necessary” in order to avoid paying for the devices.

If you have had a claim for a prosthetic limb denied by your insurance company, and you believe that denial was in violation of the law, you should speak with an attorney. Call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I can help. Call me today to learn more or to schedule a free consultation on your case.