Amputees Prosethetics Legal News Articles & Interviews

Santa Clara, CA: Prosthetics with a variety of microprocessors are the new “wearable technology” and they’re making headlines. Companies have designed the devices with

Wilmington, DE As amputees fight for insurance coverage for advanced, microprocessor- assisted prostheses, it can help to look at other insurance lawsuits that describe a similar pattern of claims denials.

LifeWatch Services v. Highmark is actually an antitrust lawsuit dealing with telemetry cardiac monitors. Nonetheless, a recent opinion in the Third Circuit, describes a pattern of denials that amputees seeking coverage for “smart prostheses” will find strikingly familiar. The heart monitors, like the microprocessor-powered feet and legs are rejected as “not medically necessary” or “investigational.” The denials, sometimes in exactly the same language, are consistent across the Blue Cross Blue Shield network of insurers. Why is this so?

LifeWatch offers two strategic thoughts for amputees fighting for insurance coverage:

Washington, DC Lucky to live, unlucky to lose a foot or a leg, survivors of the Boston Marathon bombing soon found themselves facing the harsh truth of inadequate insurance coverage for their prosthetic care. Years on, the good news is that microprocessor-enhanced artificial limbs have gotten better. The bad news is that insurance companies like Anthem and United Healthcare still balk at paying for them. Insurance lawsuits since then have taken particular aim at the internal review standards insurers use to determine whether a medical treatment or device is “medically necessary.” The standards do not line up with what amputees need most and what these modern devices can really do. Cost cutting vs. good health – it’s the match of the century.

Fear of Falling

Los Angeles, CA In California and other states, amputees are denied insurance coverage for modern prostheses. These legs and ankles are hugely better than the old titanium alloy stilts because of their microprocessors. Lt. Dan was glad to stand with his bride, but imagine running up the stairs or dancing at a Gump-ish wedding. Nonetheless, Anthem, United Healthcare and other insurers plead shock, confusion, and a general lack of evidence when asked to pay for the more modern prosthetics. The ensuing insurance lawsuits have taken aim at the insurers’ claims that the advanced prostheses are not medically necessary or still experimental.