I want to know my rights on how to get these policies with insurance changed. There’s so many amputees that give up on walking because all these companies (no matter what you pay) won’t cover the prosthetics (Medicare and prosthetic devices) that hands down would allow so many the ability to walk. I’m an amputee for 13 yrs i feel discriminated against for I was told by my insurance company that they never covered my knee when in fact they did and have papers to show they did. Even with drs telling them I need this particular knee as the other one is worn out and I had revision surgery. they now refuse saying they never did cover it. I appealed internally and externally denied. They said it’s a Luxury. Since when did needing a particular device to walk become a luxury. I walk 3-5 miles a day. I’m now faced with the fact of after learning to walk again that I may not be able to very much longer because I can’t afford this knee out of pocket. That I will be in a wheelchair because someone decides what I need to walk is a luxury. They will cover a $27,000 knee that I fell with every other day and can’t go back to because you can’t trust it at all. It also risk more injury. I also went through one of those every year and half. I fell with my son at 8 months one time busted my knee and elbow up protecting my son.
That's when someone graciously gave me the other knee from a man that just passed away. I also have two titanium rods in my spine that put me in a very bad situation when it comes to walking and falling. These knees run around $60,000 but last 3-5 yrs and don’t let you fall because they have microprocessor that’s programmed to you. You can actually trust this device and therefore don’t give up because you fell down. They lead you to continue life and prosper instead of on the ground depressed and give in to sitting in a wheelchair thinking you just can’t do it because the insurance that you pay for won’t help cover what you need to confidently walk again. Because it’s a luxury. On the other hand I had done a pre-authorization a day of physical therapy assessment that the insurance did cover a new knee years ago when the knee given to me worn out. After my revision surgery the drs said it was time for a new knee and that’s when they denied it and denied that they had ever covered it before. I have also been told that they won’t cover a socket (part around the actual limb) that is adjustable- it cost $7000 cash. It is more open concept allowing muscles to form to have more control and protect the nerves that cause so many pain every day. But they will pay for the one that is solid plastic that doesn’t breath and you have to have a new one made if you gain a pound or loose a pound , it also cost $7000 It too is a luxury.
There is more to this problem with insurance though.
I just want to know can I or we obtain a lawyer to fight for our right for the ability to walk? Or continue to walk and the right to have services provided to lessen our pain that doesn’t have anything to do with medication but physical abilities with the anatomy in my case and many others. I have asked when selecting my insurance of what was covered as far as this concern and was told they didn’t know what the details of that would be as to if they covered the device I need to continue to walk. Pretty sure they should have a recording of her stating that. Therefore I was uninformed while signing up for the policy of the coverage even though I really had no choice but stuck with the one and only company for coverage if I was to get a subsidy. Are they not supposed to be able to help me with that information before I sign up for the policy? I had no option to look anything up because they had me on the phone after I had tried signing up before the deadline and had to leave my name for them to call me after the deadline. Are they not supposed to make me whole again regarding coverage ? If they won’t provide me with this device I am not whole, they say I don’t deserve to walk because something would cost more in the beginning cheaper in the long run but last longer it means it’s a luxury?
Do you consider your type of shoe with an arch in it a luxury if it helps you walk better? This is the well being of someone’s capabilities mentally and physically that they are withholding services of preexisting conditions that won’t ever change. The ability to walk. None of us ask to be like this or want to be like this I feel they are putting a label that we don’t deserve to walk or have the devices we need because we are less than normal people. That our disability of not being whole means we should just give up on walking, living and be ashamed to confine ourselves to a bed or chair with no job mooching off the government more than needed because it’s too much to provide services we pay a monthly premium for because they are judgemental deciding if we deserve the right to walk even if it saves them money in the long run being I can’t ever get better and grow a leg back to just be wasting the money spent. Makes no sense other than discrimination to me.
Quick reply - medical insurance policy coverage (prosthesis):
Under the health care law, plans must cover treatment for pre-existing conditions from the first day of coverage.
- Coverage harsh reality for amputees
- How to Know if Insurance Will Pay for Prothesis
- While each individual's health insurance will differ, most insurance providers will cover some if not all of the costs associated with your prosthesis. Reality?
- Health coverage options for people with disabilities in the Health
- The Cost of a New Limb Can Add up Over a Lifetime
- The price of a new prosthetic leg can cost anywhere from $7,000 to $70,000. But even the most expensive prosthetic limbs are built to withstand only three to five years of wear and tear.
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