Insurance and the C-Leg

Posted by: Nate
Posted: Tue, November 10 2009 at 4:22pm

In this day and age one of our most contentious issues is that of health insurance.  The news stories are awash with reports of irate citizens attending meetings with their elected representatives telling them what they do or don’t want.  The issue of health care and health insurance is especially critical for the amputee community and thus I figure that it bears talking about. 

I have been an amputee now for just over eight years.  In that time I have purchased, through my insurance, four knees.  I have my preparatory prosthesis, a weight activated knee; I have my first and now second generation C-Leg; and I have a water proof knee for water activities. When you combine the costs of these four knees I’m sure that I’m near, or over, $100,000 in value.
I received all four of those knees when I had good insurance through my own, or my wife’s, employer sponsored health insurance plans.  Now, I’m in a situation where I must provide my own individual health insurance and no longer have an employer sponsored option.  So, what is a guy to do?  I for one do a detailed scanning of insurance documents to see how they cover durable medical equipment, which includes prosthetics.  Some insurance plans include a lifetime cap that you must be aware of and careful for; I’ve heard of some that limit expenditures to $5,000 total – that’s barely enough for a foot these days, let alone an entire prosthesis!  Another thing we can do is to lobby for national prosthetic parity.  The Amputee Coalition of America (ACA) has a campaign to do just that.  It would provide a consistent standard of coverage for all insurance companies to cover prosthetics.  This effort is an attempt to make prosthetic devices attainable to all amputees. 

In my travels and talking with dozens of amputees I have learned that prices for these great new technologies vary by region so it’s hard to say what a C-Leg will cost where you live.  Every C-Leg is different; for some people they only need the knee unit, others need a new knee and foot; yet others, a socket as well.  As you can see the only way to know the cost for sure is to talk directly with your prosthetist. 

Is monetary cost the only way to talk about prosthetics?  I think that we are shortchanging ourselves if we talk about the C-Leg only in those terms.  Yes, cost is of course a factor in deciding whether or not to purchase a knee unit, but it shouldn’t be the only criterion.  What about the intangible benefits that the knee provides?  Like promoting a natural gait; thus reducing strain on the muscles that would normally compensate for poor gait habits.  What about safety?  Stumble recovery keeps you from kissing the ground, protecting you from injury and in theory saving you money over a conventional prosthesis by not having to pay surgery costs for broken bones.  Let’s not forget quality of life factors like capability and mobility, and allowing you to live your life the way you choose. 

I realize that this topic is not an easy one to talk about.  Few things get my blood pressure rising like talk of health insurance (a rant for another time perhaps) but it’s a topic that’s relevant and ever-present in today’s world.  So, think about your insurance, find out the details, and talk with your prosthetist if you are interested in the C-Leg.  I hope that you are able to have the insurance coverage that you need to receive a quality prosthesis that improves your life. 

Until next time.
Nate

Otto Bock HealthCare pays Nate a small fee for his essays.