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.

As of May 2021, Anthem changed its policies to cover both microprocessor-controlled knee and foot-ankle prosthetic devices if individuals meet all the following criteria:

• They have adequate cardiovascular health and cognitive function to learn how to use the higher-level prosthesis
• They have functional K-Level 3 or above
• There is a documented likelihood that the microprocessor-controlled prosthesis will improve mobility and stability better than a mechanical prosthesis
• There is a documented need for unassisted walking in situations such as ascending or descending stairs, walking for long distances or walking on uneven surfaces where the higher level prosthesis will provide benefits.

Under these updated Anthem policies, a wide range of consumers can receive coverage for their microprocessor-controlled knee prosthesis. However, individuals may have been denied in the past. Those who had their requests for microprocessor-controlled prostheses denied under former policies can resubmit their claims for review under the current prostheses policy.

Additionally, those who paid out of pocket for these devices after their post-service claims or pre-authorization requests were denied under previous policies can receive reimbursement from the settlement. These insureds must include documentation such as health care provider information, services rendered and total charges for prostheses.

The deadline for exclusion and objection is July 28, 2022. 

The final approval hearing is scheduled for Aug. 29, 2022. In order to speak at this hearing, class members must submit a notice by Aug. 8, 2022.

To benefit from the Anthem lawsuit settlement, class members must submit a valid claim form. The deadline to submit a claim has not been decided.

Who’s Eligible

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.

Potential Award

Varies

Proof of Purchase

Insurance information and other documentation that demonstrates that you incurred and paid out-of-pocket for a microprocessorcontrolled knee or foot-ankle prosthesis.

Claim Form

NOTE: If you do not qualify for this settlement do NOT file a claim.

Remember: you are submitting your claim under penalty of perjury. You are also harming other eligible Class Members by submitting a fraudulent claim. If you’re unsure if you qualify, please read the FAQ section of the Settlement Administrator’s website to ensure you meet all standards (Top Class Actions is not a Settlement Administrator). If you don’t qualify for this settlement, check out our database of other open class action settlements you may be eligible for.

Claim Form Deadline

TBD

Case Name

Lacy Atzin, et al. v. Anthem Inc., et al., Case No. 2:17-cv-6816, in the U.S. District Court for the Central District of California

Final Hearing

08/29/2022

Settlement Website

AtzinSettlement.com

Claims Administrator

Atzin Settlement Administrator
c/o Rust Consulting – 7470
PO Box 2599
Faribault, MN 55021-9599

Class Counsel

Robert S Gianelli
GIANELLI & MORRIS, A LAW CORPORATION

Defense Counsel

Kenneth N Smersfelt
REED SMITH LLP