Additional Coverage:
Health Insurance Coverage for Prosthetic Limbs
Michael Adams, an amputee, encountered a hurdle in obtaining a new prosthetic leg due to his health plan denying it as “not medically necessary.” This despite Colorado law requiring insurers to cover prosthetics.
The denial highlights a disparity in insurance coverage, as joint replacements are typically covered without question.
Prosthetic coverage varies widely among private health plans, with some imposing caps and restrictions on devices. An estimated 2.3 million Americans live with limb loss, and coverage gaps can hinder their access to necessary prosthetics.
In the US, Medicare covers prosthetic limbs at 80%, but only 30% of beneficiaries who lost a limb in 2016 received a prosthesis within three years.
The Amputee Coalition reports that many with limb loss face financial challenges in acquiring prosthetics, leading to payment plans or loans.
The Consumer Financial Protection Bureau has proposed a rule to prevent lenders from repossessing medical devices like prosthetics if borrowers default.
Leah Kaplan, born without a left hand, has been denied coverage for a prosthetic hand for everyday use, despite her doctor’s recommendation. She has appealed three times without success and plans to file a further appeal.