Amputation: Insurance woes

14 years ago, Laura Brumund lost her leg in a car accident. Today she is eager to get an improved prosthetic leg housed with a computerized knee. However, her insurance carrier has repeatedly denied her for coverage. The insurer claims that the knee is experimental and unnecessary. To Laura, however, the new knee is vital to help her keep up with her active 4-year-old son.

Accident victims, like Laura Brumund, who suffer serious injuries that require limb amputation or limb reconstruction, can incur extensive medical bills for recovery and rehabilitation. While technology aspires to restore amputees to an independent lifestyle, the rising cost of these advancements coupled with insufficient insurance coverage is sure to thwart progress.

The cost

The average cost of prosthesis directly relates to the type of procedure subsequent to the fitting. Studies calculate the cost over $81,000 for patients treated with reconstruction and over $91,000 for patients who had their limb amputated. Moreover, these studies project the lifetime healthcare cost at $509,275 for patients who undergo an amputation. The cost for patients treated with limb reconstruction is three times higher at $163,282. Inclusive in the cost is maintenance and replacement of the prosthetic device. Keep in mind that most devices must be replaced every three to five years.

Inadequate Insurance Coverage

Insurance companies tend to cap coverage of prosthetics at $1,100 for the lifetime of an amputee. Usually coverage does not include repairs or replacements. So, a prosthetic to fit an above the knee amputation — which includes a full prosthetic knee, foot and socket — the insurance does not come close to covering the total cos of nearly $40,000. The socket is the most expensive part because it is customized.

The Amputee Coalition of America continues to lobby state governments to write legislation which require insurance companies to cover prosthetics. The insurance industry, argues against such laws contending that they amount to healthcare mandates. Furthermore, It claims that by covering expensive artificial limbs for small group of people would only boost health care costs for the larger insured population. So far, only a few states have passed such bills.

Experienced Florida legal team

Insurance companies are in business to make huge profits; it takes an experienced legal team to induce them to pay appropriate settlements. If you’ve been hurt in an accident, contact us. It is crucial that a person who has suffered an amputation receive full compensation from the negligent party. If you have any questions on this blog or need information on other personal injury queries, please call the Law offices of Lytal, Reiter, Smith, Ivey & Fronrath located in West Palm Beach at 1-800 4-RIGHTS (1-800- 474-4487) We welcome your call and look forward to helping you.