I am facing an above the knee amputation and have heard that my insurance company may put restrictions of the kind of prosthesis I will get. Is there anything I can do about this?
Yes there absolutely is!
Your physician and prosthetist will work closely together to determine the best prosthesis for you and your lifestyle. Insurance companies require an in-depth assessment which will determine your potential function with a prosthesis. You may be assigned a K-Level (this is a functional level often used by insurers) based on this assessment. The higher your K-Level (scored as K0-K4) the greater potential or assumed function you will have on a prosthesis. This may determine the type of prosthesis available for coverage by your insurance company.
Your physician, prosthetist, and possibly physical therapist will perform in depth evaluations to determine this level, but it is important that you share important activity and lifestyle information with them. Documenting lifestyle information, such as how many stairs are in your home, what kind of activities you engage in, or engaged in prior to amputation, provides your evaluators with important information to help your “medically necessary” claim stand review. A written diary of your activities or even an activity tracker such as a fitbit or pedometer, are excellent tools to record this valuable data. The $30 – $150 investment may help justify a prosthesis that can cost $3000 – $120,000.
Once you receive your prosthesis, maintaining regular visits with your prosthetist are helpful in the documentation of your prosthetic care. Sometimes “proving” what is not working can help make the case for getting the prosthesis you need. Even when all is well keep your scheduled follow-up appointments – you never know when your documented history may be important in an insurance negotiation.
At Reach fitting our patients in the highest functioning prostheses (that is appropriate for the condition) is our goal. Devices that keep the patient active result in better health and a more positive lifestyle.
For more information on K-Levels see: http://www.amputee-coalition.org/inmotion/2013-iss5-sep-oct/do-you-know-your-k-level.pdf
John Robb, CPO