Make It Personal

Amputation is a tough road. If you make the decision to amputate or if your limb is taken from you by accident or disease it’s a bumpy ride, right from the get go. Most people assume that once you get through the surgical part and physically heal that you are back to life as usual. that couldn’t be farther from the truth. As an amputee with 6 1/2 years of experience I can tell you that once I healed and was able to get fitted with a prothesis my journey of ups and downs was just beginning. The one aspect that I am extremely grateful to my GP for pointing out to me was insurance. Even though I had my head wrapped around the idea of taking my leg, and I knew I had the grit and determination to tolerate all the limb changes that were coming, I needed to be sure that A) I knew what type of prosthesis I needed to live an active life and B) that my insurance covered it. What I fought for: This was the beginning of the most emotional and draining 4 weeks of my life. This was a fight I wasn’t prepared for, even though I thought I was. This week I take you through what I did to cover myself, (or at least thought that I was covered), what happened that spun me out of control for 4 weeks, and how I bounced back to fight for the leg I needed to live a good and healthy life. You may have to deal with this for yourself or someone you love, it’s good information, and from someone who now has to fight every 3 years to get the leg she needs to be mobile and I hope that my story helps you in your fight. “No”should never be the answer when someone wants to be as mobile and healthy as they can be. We must learn how to prepare to face the insurance giants and how they work so we can be ready to stand up for ourselves and the lives we want to lead. It’s no easy task but it is one worth our time and energy. Remember the old saying, “The squeaky wheel gets the oil?” That became my motto that entire month I fought for my prosthesis. Are you facing this blockade in your future, or even right now? Check out how I went to battle and what you can do to prepare yourself. Let’s get prepared! First, understand your insurance plan. Look for what is covered under external prosthesis devices and what is needed to be approved, usually notation from doctor of it being “medically necessary”. Second, get with your prosthetist and find out exactly what type of prosthesis you’ll be getting according to what your lifestyle was, what you dream of doing, and what you will be capable of (Usually you’ll take a K level test to determine your ability-my PT did this with me). Third, get the code(s) that can be tricky and denied by most insurances and start making the call to your insurance company and ask if it’s covered by your insurance. I even went to the extreme of calling my insurance company multiple times over the 4 months before my surgery to hear different employees tell me that “Yes, that code is covered.” Now they had it on recorded phone calls (Important to know that all calls are recorded, however, if you ask for the recordings they will tell you that your lawyer will have to file for them!!! Yes, I asked because I thought I was going to have to sue them for undo stress!). This should be a great start to getting your approval, but even though I did all of these things, I actually got a big ‘ole “NO!” after my amputation… and while I had done my due diligence I hadn’t planned on my insurance company changing the wording on my plan after the first of the year to NOT include the code that was previously approved. These are the unknowns you can’t prepare for but must find it in yourself to fight beyond that. You need to connect with people that can help, your doctor, your prosthetist, the prosthetic company even has their own insurance coordinator, and MAKE IT PERSONAL! I made sure the calls I made to supervisors every day that month that I told them who I was, about my family, and my hopes and dreams I had for my future. You are NOT a claim number you are a person with a life. Make them see that and feel that. These are just some starting points but I hope they help you navigate the crazy world of insurance claims. Now get up and fight for your life of your dreams! Don’t take No for an answer, dear Warriors! Rise up and fight!! Have a beautiful day and as always, Be Healthy, Be Happy, Be YOU!!! Much love,