I’m sorry to hear about your accident. Working with insurance companies for prosthesis coverage can at times be tricky. It can be especially difficult when you are seeking coverage for something that’s not medically necessary, such as cosmeses.
Cosmeses are cosmetic coverings that give prosthetics a more natural appearance. Unfortunately, some insurance companies have claimed that cosmeses are not reimbursable under their policies, because they are purely cosmetic and are not necessary to the operation of the limb.
As an amputee, you understand that appearance is important to almost all amputees. Also, cosmetic coverings are typically very durable and can actually enhance the device. Many doctors consider the cosmetic cover of the limb an essential part of the device, and one that should not be chosen by an insurance company or any other party except the amputee.
You can pursue several avenues for paying for the cosmetic covering for your limb. If your insurance company refuses to approve the expense, you can file an appeal. You may also wish to get an attorney involved who can help make a strong case that the insurance company is acting in bad faith by denying your coverage. Also, if you were in an accident that was caused by the negligence of another party, you may be able to obtain compensation from his or her insurance company or personal assets for your damages.
Call me, Conal Doyle, Amputation Lawyer at 310-385-0567 if you are an amputee and you need assistance with a legal claim. I am also an amputee and I can help. Call today to learn more or to schedule a free consultation.