Blue Shield of California was recently sued for failing to provide certain types of artificial limbs to its members suffering from limb loss. Two of its members sued the company for its failure to properly compensate for artificial limbs.
The company’s written guidelines on coverage provided that “benefits are provided for Prostheses for Activities of Daily Living at the most cost-effective level of care that is consistent with professionally recognized standards of practice.” However, the company has refused to pay for microprocessor-controlled prostheses. It claims that the limbs are investigational, although there have been studies showing that the devices provide significant benefits over mechanical feet.
In addition, there is a significant amount of evidence that microprocessor-controlled limbs are effective. The limbs respond to constant feedback from sensors to the device’s computer, which changes the foot based on walking speed, incline, decline, and type of terrain. They allow for a more normal bend at the ankle when walking so that there is a reduction in toe drag, as well as better balance. This can help reduce falls and create better stability.
If you suffer from limb loss and your insurance company has refused to provide you with the proper limb, call me, Conal Doyle, Los Angeles personal injury attorney, at 310-651-8272. I am currently working on three lawsuits against insurance companies and would be happy to talk to you. Call today to learn more or to schedule a free consultation.