People who suffer limb loss typically need prosthetics to help them maintain full quality of life. Unfortunately, while prosthetics have become vastly more advanced in recent years, they’ve also become extremely expensive in many cases.
Insurance companies can help cover the costs of a prosthetic limb, but answers to the questions of who qualifies and how much is covered are not always obvious.
With that in mind, let’s take a closer look at what you need to know about prosthetic limbs.
The Facts About Prosthetic Limbs
It’s estimated that more than 2 million Americans live with limb loss. While most of these people will use a prosthetic limb, the type needed, and cost of these limbs can vary considerably depending on a variety of factors.
First, the type of amputation the person undergoes may affect the type of and cost of a prosthetic. Larger or more serious amputations may require a more expensive limb. The same holds true for the age and activity level of the person who needs the limb. A younger person who is exceptionally active needs a limb that is sophisticated and provides a very high level of functionality. Prosthetics made from cutting-edge technology featuring advanced materials are longer lasting and more closely replicate the functionality of the human arm, leg, hand, and feet.
Who Covers the Cost?
For most people, the cost of a prosthetic limb, at least in part, is covered by one of the following:
- An employer-based insurance plan
- An insurance plan purchased privately or through a government exchange
- Medicare coverage
- Medicaid coverage
The amount covered varies considerably depending on the type of insurance that one has. For example, The US Centers for Medicare and Medicaid have a specific protocol they use to determine whether a person qualifies for a prosthetic limb. State laws, which are variable, may also influence eligibility.
Employer or private health plans, meanwhile, will also make assessments about eligibility and the amount they will cover.
In some cases, a physician may recommend a certain prosthetic device, only to have an insurance company issue a denial because it is no medical necessary. Fortunately, there is a way to challenge these denials.
How an Attorney Can Help
If an insurer is refusing to cover the cost of a prosthetic or offering to pay only for a cheaper, less functional model, it’s possible to contest this decision via the legal system or via negotiation.
An attorney and a medical professional can work together to help make a case that denied claims for prosthetics are in fact medically necessary.
In the past, many such claims have been contested and won, and attorneys have helped uncover widespread patterns of unfair denials issued by insurers seeking to keep costs down.
If your insurer is engaging in similar activity, an attorney can help you fight to receive the full coverage to which you are entitled – and help protect your quality of life.