The battle of the amputee VS the insurance provider

Did I ever think that I would be sitting around 5 months post-amputation without a prosthetic of my own? Not in my wildest dreams... yet here I am! Health insurance: can't walk with it, can't walk without it. The very first thing I did once I had processed the shock of learning I would need an amputation is research. I read countless articles about the surgery itself, recovery, and what I should expect once I was ready for my first prosthetic. I visited several prosthetic clinics, I called my insurance provider and read the details of my policy thoroughly. I thought I did everything right. I knew I wanted a microprocessor knee based on my mobility needs and I was assured this would be no problem. This gave me peace of mind through my early recovery when I was so anxious to walk again. I focused on learning about all the things others had achieved with this kind of prosthetic. A microprocessor would give me much more stability than the more antiquated basic style of prosthetic. If it is being approved for those in their 70s who are still somewhat active I would surely be approved at my age..

My prosthetist taught me how to walk with an Ottobock C-leg 3 as it was the style he felt I would do best with. It took what felt like ages to finally hear back from my insurance and it wasn't the news I was expecting. I had been denied due to "a lack of medical necessity for a microprocessor style knee". I KNEW that this must be a mistake. I told myself not to panic and proceeded to call Cigna myself. I was told that it was in fact due to my policy not including power devices and that it only allowed for a "basic" prosthetic. I explained that the prosthetic ordered by my clinic was actually not a power device and that this is a common misconception. A power device is designed to replace muscle activity and uses sensors to respond with movement. Microprocessor knees adjust the swing phase of the "knee" to provide you with a more natural and stable walking pattern. Unfortunately, many insurance providers are not familiar enough with these devices to understand the differences. I was told I would need to file an appeal which would take an additional 3-6 months.

After an emotional day of self pity and far too much pizza, I thought why am I just accepting no so easily? Sure, it may not work out. I may not end up with the exact prosthetic I want for now... but I am not going to sit around feeling bad for myself. And I am not simply going to accept the explanation of someone who sounded unsure about exactly what my policy includes. I have since reached out to my doctor for additional documentation of medical necessity and am working with my prosthetic clinic to clarify the specific language of my policy details. If you have insurance through your employer, you may not be aware that your HR department has a representative assigned to be your advocate and help you with any concerns regarding your insurance policy. I encourage you to use this benefit as they are knowledgable and can have more power when it comes to influencing your provider.

Were it not for the team at my incredible clinic who have allowed me to take home the c-leg I have been learning to walk with until we can sort out mine, I would still be on crutches. She may not be my own, but I felt she deserved a name since we has taught me so much. Her name is Lucy and I try to care for her as best I can... except for the time I took her out of town and forgot her charger so her battery died and I had to drag her around looking like a zombie. For those of you fighting to get equipment treatment, or medication covered by your insurance provider, do not give up. Do your research, talk to your doctor and fight for what you deserve. Learn as much as you can about what your rights are. This is your life and your mobility after all.

I know it can be so hard to stay positive when you feel like everything is stacked up against you. I know that it can feel impossible to go on at times. Still, I want you to fight even harder for your spirit than you do for a prosthetic. Work to make your own happiness because there will always be challenges and there will always be moments of defeat. It is up to you to pick yourself up, crutches and all, and look for sunlight.