The deal, announced Wednesday, provides “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 microprocessor-controlled knee and foot-ankle prosthetics if certain criteria are met, and it’s agreed “not to change its position unless such change is warranted by a change in the medical literature,” according to paperwork filed in the U.S. District Court for the Central District of California.
The deal, which is expected to benefit more than 100 people, also allows class members who paid out-of-pocket for their prosthetic devices to resubmit their claims to Anthem if they haven’t already been reimbursed by other insurance or Medicare.
The lawsuit accuses Anthem of refusing to cover computerized prosthetic devices for knees, feet, and ankles on the grounds that they’re not medically necessary. The patients say Anthem incorrectly treated these devices as “investigational,” despite them being accepted by the medical community and routinely prescribed for patients with limb loss.
The lawsuit is pending before Judge Otis D. Wright II, who certified the case as a class action in 2020.
The patients are represented by Gianelli & Morris ALC and Doyle Law, which stand to receive $850,000 in attorneys’ fees if the deal is approved.
Reed Smith LLP represents Anthem.
The case is Atzin v. Anthem, Inc., C.D. Cal., No. 2:17-cv-06816, motion for preliminary settlement approval 10/20/21.