Los Angeles Anthem Prosthetic Limbs Denial Lawyer

According to the Amputee Coalition of America, there are 185,000 new amputations involving lower extremities each year in the United States, making for an estimated 2 million American amputees in total. Furthermore, the amputee population is predicted to more than double to 3.6 million by the year 2050.

Being an amputee presents many challenges in your life. Obtaining insurance coverage for prosthetic limbs should not be one of these challenges. If Anthem has denied your claim for a prosthetic limb, a Los Angeles Anthem prosthetic limbs denial lawyer may be able to assist you in getting the claim approved.

Insurance Coverage for a Prosthetic Limb(s)

Most insurance companies place lifetime caps on prosthetic coverage. Some may also have exclusions or unusually high deductibles. Still others, Anthem included, may simply deny a prosthetic limb claim. All told, nearly half of the members surveyed from the Amputee Coalition of America report that they have had ongoing insurance reimbursement problems.

In addition, many private insurance companies attempt to match an amputee with what they believe is the most cost-effective equipment that meets the criteria of medical necessity. While this is a smart and effective financial move for insurance companies, it can be detrimental to those who need prosthetic limbs, and sometimes even illegal. Amputees may be able to benefit from consulting with an Anthem prosthetic limbs denial lawyer in Los Angeles to find out what their rights and options are.

Health Insurance Policies as Contracts

Often to their own benefit, insurance companies like Anthem have claimants who either forget or do not realize that their health insurance policy is a contract. The insured agrees to pay their premiums and abide by other terms set forth in the policy. In turn, the insurance company agrees to pay certain claims and follow additional provisions.

Many times, when a prosthetic limb claim is denied, Anthem is acting in a manner that is not congruent with the terms of the policy or is in breach of the contract, which is illegal and unethical. However, they will likely continue to do so unless they are called out on their actions.

One way of calling them out is for a policyholder to hire an attorney and take their claim in court. If found guilty of a contract breach, Anthem may be forced to pay for the claim and for other damages.

How a Los Angeles Anthem Prosthetic Limbs Denial Attorney Could Help

A Los Angeles Anthem prosthetic limbs denial lawyer may be able to get you the coverage that Anthem has a contract to provide you, in addition to compensation for your trouble trying to overturn their original decision. An attorney could also present you with additional options such as filing an appeal through Anthem’s internal processes, taking the case before the state’s review board, or even going to court to have a policy legally enforced.

Skilled lawyers who are well-versed in insurance laws surrounding prosthetic limb claims are available to take your denied claim before a judge or jury, if need be. Call today to learn more about denied insurance claim legal services and how you may be able to benefit from them.