I am an amputee and my doctor has recommended osseointegration. Will my insurance company cover that?

Whether or not your insurance company will cover osseointegration is unclear, but it is possible it could be labeled an “experimental procedure” and coverage could be denied. Osseointegration is an implant that attaches to the bone in a residual limb, and goes through the skin. The implant takes the place of a socket, and it is intended to be used by the amputee for the remainder of his or her life.

Most amputees with prostheses use sockets. However, there are a number of issues with a socket, including problems with skin breakdown, pain, and other issues. Osseointegration can help with many of those issues, and has become more common across the world. Currently, osseointegration is only used with nonvascular amputations, such as those that occurred due to trauma or sarcoma.

The FDA is conducting clinical trials right now to find out if osseointegration is safe, and if it is a good alternative to using a socket. The FDA has approved the use of osseointegration, but only in limited circumstances until further studies are done. Osseointegration is being done currently in a number of other countries. Australia is currently leading the world in osseointegrations.

Because the FDA has only approved osseointegrations in limited circumstances, it is likely your insurance company would deny any payment for that type of procedure. However, if you believe that your insurance company is denying charges related to your amputation in bad faith, you may wish to speak with an attorney. Call me, Amputation Attorney Conal Doyle at 310-385-0567. I am an amputee as well as a personal injury attorney. Call today to learn more or to schedule a free consultation.