Anthem microprocessor-controlled prosthesis coverage class action settlement

Anthem agreed to a class action lawsuit settlement to resolve claims it wrongfully denied insurance coverage for microprocessor-controlled prostheses.

The settlement benefits individuals covered by Anthem health insurance plans who were denied coverage for microprocessor-controlled knee or ankle prostheses as a result of Anthem’s Former Medical Policy on Microprocessor Controlled Lower Limb Prosthesis, Policy No. OR-PR.00003.

Anthem Blue Cross Blue Shield is a health insurance plan provider which offers a number of plans for Medicare, Medicaid, families, small businesses and other employers. Through Anthem plans, individuals may have coverage for medical, dental and vision services.

According to a class action lawsuit, Anthem wrongfully denied plan participants coverage for microprocessor-controlled knee and ankle prostheses. The company allegedly used excessive criteria to deny claims for microprocessor-controlled prostheses including requiring people to prove that they could master a “faster than normal walking speed.”

“While a microprocessor-controlled knee prosthesis may allow a person to walk faster, plaintiffs alleged this was only one of the benefits of the device and failed to recognize that they also allowed people to accomplish ‘normal’ activities of daily living,” the Anthem class action lawsuit contends.

Plaintiffs in the case say these and other unreasonable requirements caused numerous insureds to be denied coverage for prostheses that would greatly improve their quality of life.

Anthem hasn’t admitted any wrongdoing but agreed to pay an undisclosed amount to settle these allegations.