Anthem has ended a class action suit related to its refusal to cover microprocessor-controlled lower-limb prostheses by expanding its coverage of the devices for its insureds.
The deal provided “substantially all of the relief requested” in the Employee Retirement Income Security Act lawsuit, plaintiffs Lacy Atzin and Mark Andersen said in their motion for preliminary settlement approval. Anthem has agreed to cover the knee and foot-ankle prosthetic devices if certain criteria are met, and it agreed “not to change its position unless such change is warranted by a change in the medical literature,” according to paperwork filed in the US District Court for the Central District of California.
Members of the suit who paid out-of-pocket for their prosthetic devices can resubmit their claims to Anthem if they haven’t already been reimbursed by other insurance or Medicare.
The lawsuit, certified the case as a class action in 2020, accused Anthem of refusing to cover the devices as investigational and unnecessary despite them being accepted by the medical community and routinely prescribed for patients with limb loss.
