Prosthetic Categories

Anthem Now Covers Microprocessor-Controlled Lower-Limb Prostheses

    Health insurance provider Anthem Inc. (Anthem) has expanded its coverage to include microprocessor-controlled foot, ankle, and knee prosthetic devices. This ended a class-action lawsuit that contested the company’s classification of these devices as investigational and therefore unnecessary.

     Anthem will now cover lower-limb microprocessor-controlled prosthetic devices.

    The deal was announced in October 2021. It will see the largest health care company in the Blue Cross Blue Shield Association covering microprocessor-controlled prosthetic devices if specific criteria are met.

    Furthermore, Anthem has agreed not to change its position unless warranted by a change in the medical literature.

    This change will benefit more than 100 people. It will also see plaintiffs who paid out-of-pocket for their prosthetic devices to refile their claims to Anthem if other insurance companies or Medicare hasn’t already reimbursed them.

    The lawsuit, filed in September 2017, accused the insurance provider of refusing to cover prosthetic devices for feet, ankles, and knees because they’re not medically necessary. The plaintiffs said that Anthem incorrectly categorized these devices as “investigational” despite being accepted by the medical community and routinely prescribed for patients with limb loss. The lawsuit was classified as a class action in 2020.