Posted on Friday, April 15th, 2022 at 11:57 pm
An amputation is a physically and emotionally shocking experience. Some amputations are scheduled in advance due to cancer or other serious illness. Others are the result of traumatic injuries, leading to amputation of a limb. No matter how you have come to lose a limb or other body part, you may eventually decide to have a prosthesis made.
When it’s time to decide what kind of prosthetic you want and need, you should take your time and consider what kind of prosthetic will suit your lifestyle and your daily routine.
Types of Prosthetics
Anything that replaces a missing body part can be called a “prosthetic.” The three primary prosthetics are upper limb, lower limb, and breast prostheses. Artificial eyes and even some types of reconstructive surgery also contain elements of prosthetics if they are replacing missing parts and not repairing damaged structures instead.
When you and your family and doctors are considering the best prosthetic for your replacement limb, you need to keep your ordinary routine and your preferred recreational activities in mind.
- Location and degree of amputation. Limb amputations are categorized as above or below-joint. That is, are they below the elbow or knee, or below it. The type of amputation matters a great deal when deciding what type of prosthetic you need. In the case of below-the-elbow amputations, it can also affect what options are available.
- Daily routine and activities. The prosthesis will replace a limb. You should choose one that will do whatever your original limb did. The high-tech sprinter’s feet used by parathletes look amazing, but you won’t need them if you’re going back to work as an office manager. If you enjoy hiking, you will need heavy-duty prosthetics that can handle a day on the trail.
- Appearance. Some people are understandably self-conscious about their looks following an amputation. Others work in a field where they need to present a polished appearance. You may feel you need a prosthetic that looks as much as possible like a human limb because you must wear open-toed shoes every day.
- Price and maintenance. Insurance may cover the cost of your prosthesis. Insurance may not cover upkeep and repairs. As with any complex medical device, prostheses may break, and parts and maintenance may not be included in the purchase price. Unfortunately, this must be considered when choosing your final prosthesis.
- Alternatives. It’s always tempting to go with the top of the line. There is currently an actual fully bionic powered arm enabling the user to reach over their head, with the full range of motion, triggered by a foot pedal as well as shoulder movements. It runs about $100,000. As amazing as it is, sometimes less is better. There are less expensive versions of the same type of prosthesis.
Insurance and Prostheses
Most types of insurance will pay for at least part of your prosthesis. The difficulty is not establishing that you need a prosthesis but in proving that anything more than a basic device is “medically necessary” as described by your insurance policy.
The newest generation of myoelectric limbs, especially upper body prostheses, provide more movement, flexibility, and functionality than the body-powered “hooks” that are the basic upper body limb replacement. It should seem obvious that a prosthetic limb that has elbow and wrist rotation, grip strength, and vertical and lateral movement will let the user return to more gainful employment than a hook, but that is not how insurance companies see it.
If an upper-limb prosthesis provides more than basic function, you can expect to have it denied by the insurance company. This is also true of a lower-limb prosthesis if it is designed for anything beyond walking and standing. If you need cosmetic prostheses for mental health reasons, you will be facing the same kind of denials. Insurers are not kind to people who have lost limbs.
How We Can Help
Recovering from an amputation and obtaining a properly fitted prosthesis can take several months. If your long term insurance carrier is not providing you the assistance you need, you should engage a lawyer right away. If your claim has been denied, you have a very narrow window for appeal. Don’t delay, or this window could close forever.
If your claim for your prosthesis has been denied and you want to appeal, we can help you navigate the choppy waters of the appeal. You should not have to make that journey at a time when you are trying to recover from surgery and physical therapy. Call the long term disability attorneys of Abell and Capitan Law at (267) 419-7888 for a review of your case today.