This was 27 years ago and yes, I did get a settlement. I did get my first leg for free. That was way before microprocessor controlled above knee prostheses were invented.
Sorry for not saying that earlier. Now I am trying to get my second C-leg. My family and ebay helped me with my first one 7 years ago. Now I am not quite fortunate enough to come up with 40 grand. I will probably be able to do it. But the point of my thread is insurance coverage.
As I said, If you are covered through work and break your leg, you are covered. Probably 80 percent as most plans are. Why does my prosthetic leg not get the same coverage?
IOW, you break your leg and insurance says “well you have another one, you will be ok.” Or your son daughter mom husband etc. Hard to imagine right? I am simply trying to equate that with a prosthetic limb period.
Why is the leg you were born with, and must have to walk worth more than a prosthetic leg I need to walk? My only point.
You do not understand! You don’t get free legs for life. And some that Medicare or the VA might give are worthless for active people. If you want to take the attitude of “well, he settled, so screw him” you need to research the issue.
Don’'t take the tone here that I somehow feel entitled. Sweet Og!
You know what? shove that post up your ass. Put this in the Pit or ban me I dont give a fuck. Imagine your son or daughter needing a prosthetic limb. Free legs for life! You fucking moron.
That was insulting as shit.
Google prosthetics and insurance coverage. Google Otto Bock and C-Leg. Google war vet amputees.
You are so fucking stupid and uninformed you should cut your own leg off and beat the shit out of yourself with it.
I do understand, and you do get free legs for life. I work for a workers’ compensation litigation firm and before that I was an adjuster (in Florida, which is among the tightest-fisted of states in terms of workers’ compensation benefits). You are entitled to medically necessary care for so long as the industrial accident remains the cause; in the case of an amputation, that’s forever. That can be different in states where workers’ compensation coverage is provided solely by the state, but there aren’t many of those.
I do not mean to imply that you feel entitled to something you don’t deserve, though; if anything, I would say it’s something you do deserve, and have every right to feel entitled to.
Let’s be clear - they’re not influencing whether you walk or not, but how well. You want a Ferrari. It sounds like you can come up with the $$, so if you want a Ferrari when there are Kias out there, you choose to pay for that. We all do.
7 years, $50K, so you know what you need to stash away. Or are we going to be here in 2020 having a similar thread?
And, your postings in this thread sure does have Entitled stamped on it. You are the one who’s taken that tone.
Would you rather have your real leg or the prosthetic limb? I think the assumption is that while your C-leg is about as good a replacement as you can get, it still doesn’t beat having the original leg. For example, not requiring expensive replacements is a plus. I know I’d be willing to pay a bit more to keep mine, such as it is.
It sounds like this is a case of workers comp insurance, not accident or health.
I have to echo what Really Not All That Bright said. I’m doing some work now in the workers comp business line of a major insurance company. Typically workplace injuries are covered for life in the form of lost wages and medical expenses. However, if you agree to a one time settlement, you typically lose your right to claim medical expenses down the road, should you need future treatment.
It’s not really an issue of “deserve” or “entitled”. Insurance is a business of laws and agreements. You are entitled to whatever those laws and agreements with the insurance company say you are entitled to. My advice is to speak to a lawyer who is knowledgeable about the tedious minutae of the WC laws in your state and see if there is anything that can be done.
This flippant remark is hilarious wrong. You could I suppose, correctly answer “markets”, and specifically, look at demnd curves. You could run a 100% Socialist Command-style economy, devote virtually all your resources to healthcare, and you still probably couldn’t escape one simple fact: healthcare demand is virtually unlimited, and everyone thinks they deserve to have as much of it as they want.
I work in the industry and hear this stuff all the time–it stinks. This is why individuals with amputations need to start educating their congress men and women about the importance of insurance fairness for amputees–especially as Obamanationcare moves forward and states being to establish their definitions of essential health benefits–you want to make sure that orthotic and prosthetic devices are covered under rehabilitative care. A new C-Leg will make you a productive member of society who goes to work and pays taxes. This is an uphill battle but one worth the fight. Go in person to see your congress men and women. Educate them. Take them to your prosthetist’s office and let them see what really is a stake and what this means for people.
Thing is, prosthetics have recently advanced much faster than the insurance industry can keep up with. Myoelectric devices were almost cartoonishly useless 15 years ago, but now they’re excellent. A lot of this has to do with the Iraq war, which has created more than twice the number of amputees as a percentage of casualties than prior wars (thanks to better body armor).
Again, Klaatu, I didn’t mean to insult you. I am merely pointing out that a mechanism for replacing your leg at someone else’s cost probably existed.
I googled c-leg to get a look at how they work, and went thru a few postings on E-bay. I can’t say I completely understand the technology involved, but considering they have been around for some 10 years, I can’t understand why a new c-leg should cost $40,000. If their really is close $40,000 worth of technology and r&d in the c-leg, I’d sincerely enjoy being educated by more knowledgeable dopers.
Of course, I can’t understand why bills for a year-long broken leg should total $100,000 either, but it this case (since insurance pays 80%) there is an incentive to mark-up. For prosthetics, the situation described seems common (at least with folks who wear out their first leg after 7 years), so insurance mark-up seems like less of an incentive to hike costs.
Prostheses have to be custom fitted, and they are designed to last for up to a decade. Bear in mind that an artificial limb is in use more or less 24 hours a day, 7 days a week, and you start to realize why they have to be over-engineered. Besides that, there’s a tiny, tiny market for them relative to other electronic devices. R&D costs for, say, a Blu-Ray player are spread across millions of devices. There just aren’t that many amputees who are suitable candidates for non-fixed prostheses; if I had to guess, there are probably fewer than 5,000 C-leg users.
Please re-read my post. Yes, I know it’s long, but please do so. I used to work in health insurance I have never seen a plan - outside of maybe the one Congress enjoys - pay for more than one prosthetic limb.
No, NO ONE gets “free legs” for life. NO ONE. Except maybe someone in Congress or, maybe, through the VA (I didn’t work for the arm of the EIE that did government coverage).
I completely disagree with that. As I said, I worked in a division of a major insurance company whose sole purpose was to keep up with medical advances. As soon as the C-leg was publicly available it was reviewed and within just a few months a recommendation for coverage was made: active adults of working age should get one. If that isn’t done it’s because someone doesn’t think maximizing a working adult’s mobility isn’t cost-effective. Well, maybe not for the insurance company but both the working adult and his employer are likely to have a different view.
Yes, right now the Department of Defense has the best prosthetics. Mainly because they’re funding the majority of the current research. But once they roll it out for the wounded vets it hits the civilian world pretty quickly thereafter.
I broke my leg quite badly in 1996. I had 4 rounds of surgery, 2+ weeks in the hospital, hundreds of hours of physical therapy over a couple of years. The total in 1996 - 97 for the initial rounds of care was about $100k, after insurance discounts. I am still dealing with the fallout (severe arthritis, etc. - I basically have no cartilage in my left ankle at this point). Prescription orthotics, which although they need to be custom-made, are not exactly high-tech, and they cost over $500 a pop. Could be worse, though; they would have been covered if I’d hit my deductible. I once had a health plan that would only cover orthotics if I were diabetic, never mind that they were the cheapest and least invasive way to treat my condition. But they’d cover thousands of dollars in surgery and rehab for the same condition without question. On what planet does that make any sense?
The Synvisc injections I just finished cost over $1,000 anywhere in the U.S. just for the drug, plus three doctor visits to perform the injections, which meed to be done under X-ray so the doctor can inject them in the right spot, plus the diagnostic X-rays needed to determine that that was the appropriate course of treatment. All told, after insurance discounts, the visits aren’t that bad (I think $69 a pop because I hadn’t hit my annual deductible yet). But the drug was totally out of pocket (until I hit my annual deductible) because it’s an injectable, and therefore for some bizarro reason classified as a surgical procedure, not as a regular Rx drug.
Moral of the story? American medical care is pretty fucked up. Something’s got to give.