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Anthem Denial of Claims for Prosthesis Settlement

Settlement Structure: Claims Made

Active: Open

Case Summary:

Anthem, Inc. and Anthem UM Services, Inc. are settling a class action alleging that the companies or an Anthem subsidiary improperly denied claims relating to certain prostheses. The complaint alleged that the companies denied pre-authorization requests and post-service claims for microprocessor-controlled knee or foot-ankle prostheses as being “investigational” and “not medically necessary.” Anthem has now revised its policies so that insureds can request the prostheses again or can request reimbursement if they paid out-of-pocket for them.

Docket Number:

2:17-cv-6816 ODW (PLAx)

Company: Anthem Inc.

Filing Deadline: January 1, 2100

Objection Deadline: July 28, 2022

Exclusion Deadline: July 28, 2022

Final Approval Hearing: August 29, 2022

Proof of Purchase:

If you are requesting reimbursement, you must provide proof of billing and payment.

Eligibility:

You may be eligible if you belong to either of the classes below:

- The Atzin Knee Class is all persons covered under Anthem plans governed by ERISA, self-funded or fully insured, whose requests for microprocessor-controlled knee prostheses have been denied during the applicable statute of limitations period under Anthem’s former medical policy on micro-processor controlled lower limb prosthesis, Policy No. OR-PR.00003.

- The Andersen Foot-Ankle Class is all persons covered under Anthem plans governed by ERISA, self-funded or fully insured, whose requests for microprocessor-controlled foot-ankle prostheses have been denied during the applicable statute of limitations period under Anthem’s former medical policy or revised former medical policy on micro-processor controlled lower limb prosthesis, Policy No. OR-PR.00003.

The claim deadline has not yet been determined.

Typical Settlement Amount:

Those whose requests for the prostheses were denied under the old policies during the class period and who paid out-of-pocket for the devices may submit a claim form requesting reimbursement, minus the cost-sharing you would have been subject to under your policy. Those whose requests for these prostheses were denied under the old policies during the class period, but who did not pay out-of-pocket for the devices, may submit new claims. You must supply documentation and meet the criteria set forth by the new policies. Anthem will determine who qualifies for payment or reimbursement under the new policies.

Those who did not pay out-of-pocket for the prostheses but who are no longer covered by Anthem cannot request them now under this settlement, but they do not release their claims to bring other lawsuits.

Total Settlement Amount: Unknown

Class Representative Proposed Incentive Fee:

$15,000

Law Firms:
Doyle Law
Gianelli & Morris

Claim Form: Anthem Denial of Claims for Prosthesis Settlement Claim Form

Case Name: Lacy Atzin; Mark Andersen v. Anthem, Inc. and Anthem UM Services, Inc.

Settlement Website: Anthem Denial of Claims for Prosthesis Settlement Website

Claims Administrator:
Rust Consulting, Inc.

Claims Administrator Contact Information:

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

Tags: Denial of Benefits, Insurance, Medical Devices, Prosthesis, health ins