Medical science has made great strides in the development and implementation of artificial limbs. Whether in the form of new arms and hands to restore a person’s dexterity or legs to allow them to walk or run again, modern prosthetics provide people with a far greater utility than ever before. The most advanced of these devices may even interface with a person’s brainwaves to allow them greater control. As with any new technology, these items are often very expensive. While some insurance plans may cover such devices, whether or not a prosthetic limb could be paid for by an insurance company is a common source of conflict. A Los Angeles prosthetic limb denial lawyer could fight for people who wish to obtain a new or updated limb to assist in their everyday lives.
An insurance claim denial does not have to prevent a person from regaining mobility or accessibility. Consult a skilled attorney to learn about different potential options.
How do Insurance Companies Justify Denial of Coverage for Prosthetic Limbs?
Medical insurance generally is supposed to provide compensation to patients whenever they undergo a necessary medical treatment. However, the key concept here is “necessary.” In many situations, insurance companies may deny payment for a procedure or device that they do not deem necessary for the continued well-being of their customers.
Whether or not a person needs a prosthetic limb is often not a question of necessity to the patient. Rather, potential recipients argue that increased functionality is key to improving their quality of life.
Insurers may not see it that way, though. They may argue that a person already has a perfectly capable prosthetic or wheelchair that provides all the necessary functionality. In the case of the most modern artificial limbs, the insurance company may view the prosthesis as a luxury item and subsequently deny payment.
Examples of Prosthetic Limb Insurance Denials
Denials for insurance coverage of prosthetic limbs are unfortunately common. Every person’s medical situation is unique, and a single prosthetic may work wonders for one patient but prove untenable for another.
While most insurance policies cover traditional types of prosthetics, recent advances in this medical field offer many patients new and better options. When this is the case, many people face barriers to obtaining the prosthetic that is right for them. In 2009, a mother of two made national news in her fight with the Anthem Blue Cross and Blue Shield insurance company.
According to reports, the company agreed to pay for a basic pair of prosthetic limbs after a double leg amputation, but the limbs were uncomfortable and limited her mobility. The patient identified a Maryland company developing an advanced prosthetic that greatly improved her quality of life. However, Anthem denied payment for this item because—as they argued—the new legs were not medically necessary.
Ultimately, the patient was able to obtain her new prosthetics after filing an appeal with her state’s insurance board. A Los Angeles prosthetic limb denial attorney could help a person pursue a similar result in their case through all available legal means.
Contact a Los Angeles Prosthetic Limb Denial Attorney
The implementation or upgrading of a prosthetic limb may have life-changing benefits for an amputee. Unfortunately, medical insurance companies do not always see it that way and may attempt to cut costs whenever possible and may deny payments for artificial limbs that they do not consider medically necessary.
A Los Angeles prosthetic limb denial lawyer may be able to help you fight back and get the devices you need to improve your life. Call today and let an experienced insurance denial attorney work on your behalf to combat an insurance denial through an appeal.