My insurance will not pay for my prosthetic. Should I go on Medicare?

Insurance issues can be among the most frustrating aspects of living life as an amputee. For many amputees who become amputees as children, their prostheses are covered by Medicaid until the age of 18. Once they are 18, amputees are typically either covered by parents’ insurance or their own insurance, and the prostheses are paid for by a private insurance company.

Unfortunately, in many cases private insurance companies do not offer the same level of services that Medicare and Medicaid do. Insurance companies may deny an amputee the prosthesis that is required and instead may try to find a less expensive alternative. The cheaper alternative may not allow the amputee to engage in all the physical activities the amputee would like. Also, a lower-quality prosthesis can actually lead to serious health problems for the amputee, including back problems, muscle problems, and falls.

However, normally to qualify for Medicare or Medicaid (unless over retirement age), an amputee must be not working and on disability or another government program. Many amputees have rewarding careers that they may not wish to give up. Instead, the amputee should fight the insurance company. Insurance companies will reverse their decisions, but usually it takes some work on behalf of the amputee. The amputee may need to coordinate with his or her doctor, prosthetist, physical therapist, and others in order to get the prosthesis that is needed.

In other cases, an attorney may need to assist. If you’re an amputee and your insurance company refuses to cover your prosthesis, you should speak with an attorney. The insurance company may be acting in bad faith. Call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am an amputee as well as a personal injury attorney, and I can help. Call today to learn more or to schedule a free consultation.