I don’t think that is what it is. I have a coworker who had hip replacement surgery very early in life and has to get hip replacement surgery every 20 years or so. I think he pays the copay.
It probably has more to do with the fact that there is a cheaper alternative that while not ideal serves the therapeutic purpose adequately.
What? I don’t use my natural legs 24/7.
Workers comp is different from health insurance. The specifics vary from state to state, but you could conceivably receive benefits for your injury for the rest of your life, including replacement prosthetics.
Really? Even if you left the company to work for someone else? Even if the company at which you originally got hurt went out of business? If it did go out of business who would be paying for it, then?
Or maybe I just don’t see a limit to the desire of lawyers to curtail liability whenever possible.
Worker’s comp benefits are not paid by the company- they’re paid by a specific worker’s comp insurance policy, separate from your health insurance. Although the rules may have changed since my mother’s injury, she received a check from the time she was determined to have a “permanent partial disability” at least until she reached retirement age, even though she stopped working a year or two after the injury and if she needed additional medical treatment for that injury it would have been covered by worker’s comp , not her health insurance. She actually received checks while she was still working for the same company.My sister also was determined to have a permanent partial disability due to a workers comp injury- she settled for about $25,000 but lost future medical coverage because she settled. And “permanent partial disability” may include more than you think. My sister’s disability was that the range of motion of one shoulder was limited- she could raise her arm to be parallel to the floor but not straight up.
You're right about lawyers limiting liability- and worker's comp does exactly that. Because along with medical and wage replacement benefits on what is usually a no-fault basis (it generally doesn't matter if your own negligence caused the injury) , there is also a downside to worker's comp- you generally can't sue your employer for negligence that caused your injury.
I’m sure this is what it is, and it’s not limited to durable medical equipment. When my daughter was about 17, she had persistent headaches. The doctor sent us to a neurologist, who wanted to do some sort of new CAT scan. The insurance wouldn’t cover it and it cost something like $20,000. The insurance would cover a spinal tap, which according to the doctor would provide the same information and presumably had a much smaller fee. Same thing with dental insurance- my dental insurance won’t pay for multiple implants when a bridge or denture is an option. My guess is that the $3500 is 80% of the cost of what the insurance company considers an adequate prosthetic leg.
Really. This varies by degree from state to state, but in general, doreen’s post below is pretty accurate.
I will add that most states have replaced the permanent partial disability benefit with what are generally known as permanent impairment benefits; instead of getting a small check for the rest of your life, you get a few large ones for a set number of weeks based on the severity of your permanent impairment. Employees who are completely incapable of working due to industrial injuries (or a combination of injuries and vocational factors**) still get permanent disability benefits, though.
As far as who pays, for the most part it will be an insurance company. Benefit eligibility is not tied to your employment; workers’ compensation coverage is not an employment benefit (the cost of adding an additional employee to a workers’ compensation policy is not a taxable benefit), but a mandate for the company, just like liability insurance. There are some states which allow employers to self-insure, but they still have to maintain umbrella coverage in the event they go bust. Beyond that, every state* has a system like the FDIC which insurers contribute to and which makes payments in the event the insurer goes bust. In some states, like California, these are part of a general insurance guaranty system; in others, there are specific funds providing insolvency coverage for each policy type (like Florida).
The no-fault/no negligence suit aspect is known as the workers’ compensation bargain; in exchange for no-fault coverage for workplace injuries, workers give up the right to sue employers for non-intentional torts (you can still sue an employer for an intentional tort).
The workers’ compensation system actually resulted from a desire of legislatures to protect employees against employers; it was one of the great labor reforms of the first half of the last century. Prior to WC, employees were SOL when they got hurt at work since most industrial injuries are not the result of the employer’s negligence - and even those that are become notoriously difficult to prove. After all, the vast majority of the key witnesses are generally going to be on the employer’s side.
*as I noted on the previous page, workers’ compensation coverage and administration is wholly handled by the state government in some jurisdictions.
**For example, an illiterate laborer who has a back injury is probably never going to work again; even though he could do a desk job, there aren’t any he’s qualified for.
Of course you do. You might not be standing on them 24/7, but you’re moving them nearly all the time and they are bearing at least some weight a great majority of the time.
Depends on how you define “therapeutic purpose”. If you mean “enable person to stand and walk a few feet on level, smooth surface” yeah. If you mean “resume prior activities” no, it doesn’t. I gather Klaatu is unable to perform his accustomed job without his C-leg. If that is the case, and he is unable to get another, then all his experience, training, and knowledge go to waste. At best he has to be trained for other work and start over at much lower pay. Or he may simply be unable to obtain employment. I don’t see how that would benefit either him or society at large.
If I’m misunderstanding any of that I’m sure Klaatu will let me know.
But like I said, I’m a nut who thinks universal health care is a moral good and thinks rehab and “therapeutic purpose” should mean restoring someone to full function or as close a humanly possible, not going “oh, that’s good enough - you don’t deserve better”.
Also, even if he settled for a lesser prosthetic it could still easily cost $10,000 because, as noted, they have to be custom-fitted to the person needing them. For that 3500 is still pitiful. The only thing worse is the “coverage” you typically see for hearing aids, which often is even worse.
So this is slightly off-topic because the C-leg apparently needs to be replaced due to age/wear-and-tear, but…
If the leg is a piece of electronics barely covered by your medical insurance, can you just insure the leg? Pay a rider on your homeowners insurance or something, so if it breaks or is stolen it gets covered as lost property rather than as a medical expense?
I would like to apologize to Really Not All That Bright, and I understand where she is coming from
I got my leg chopped off 27 years ago, and there was not a WK issue. my simple issue today is why cannot I get a prosthetic limb covered under insurance while a co-worker can get a broken limb covered 80 percent.
I have read everything posted and understand the insurance point. My point is that ai am missing work because I am trying to find the money for a new prosthesis. I go from a new leg, or lack there off, to a wheelchair.
I accept the warning but want to make clear that getting a prosthesis does not mean one can actually live life with a prosthesis given to you by the gov… Look up K-levels from medicare.
You know what, it is fucked up when you go from productive society member to sitting on your ass.
Question: do wheelchairs get covered by American insurance the same way prostheses do i.e. you get the first one relatively free and thereafter replacements are mostly your own lookout?
No apology necessary (except for calling me “she” ;).) If I had lost a leg I daresay I’d be far touchier about it. I also understand where you’re coming from; it’s really not relevant in the abstract if you lost your leg at work or elsewhere, because you were asking for the benefit of all the other people with prostheses, too.
I think, to some degree, this is a function of the expected benefit. A new prosthesis will give you 10 more years of mobility. Fixing a torn ACL (or whatever) will give your friend a lifetime of mobility. Having said that, it’s not really a fair example, because a total knee replacement won’t last any longer than your leg and would also be covered at 80%.
Depends on the jurisdiction. In some cases, durable medical equipment can be insured just like any other home contents; you just list it in your policy as a high value item and/or take pictures for your records. In other states, you need a separate rider for it.
Note also that even cosmetic prostheses generally have to be replaced due to wear and tear. I just finished a future Medicare cost analysis on a person with cosmetic and myoelectric hand prostheses (the cosmetic one basically looks like the one Woody Harrelson wears in Kingpin, though tone matched), and we had to budget for replacements every 7 years.
If you look at the consumer goods you own, it’s really not surprising. I can’t think of anything in my house that doesn’t just sit on the floor that I expect to last beyond 10 years. My watch, but that’s made of metal.
At risk of oversimplifying, pretty much every medical aid that isn’t permanently attached to a patient, goes home with the patient, and is reusable falls under the heading “durable medical equipment” like prosthetics. That’s everything from an air cast to a home dialysis machine.
Separately, I’m going to cost out a $45,000 leg purchased every 10 years five times in a row using a real interest rate of 3%. Starting immediately. The present value sums to $136,000. That would handle our hypothetical amputee through 2062. Seems doable, though not cheap.
Actually a C-Leg only lasts about 6-7 years with a high activity level by the user.
Of course a real leg without problems is much better. The miracle of the c-leg to me is that it prevents buckling which results in falls, most of which are falling backward. Nothing will prevent a non microprocessor controlled knee from buckling.
The first prostheses I had were hydraulic knees (Mauch, from Ossur), which were state of the art at the time. They allowed you to walk normally and slow or speed up the gait to a point, and if you stumbled forward, the knee would create resistance and you could recover. However, due to the design, if you stepped on uneven terrain, and had the heel get caught behind the center of balance, the knee would buckle instantly, causing a backwards fall. This happened to me a lot and it fucking sucks. Not to mention other injuries incurred because of the fall.
The c-leg eliminates this because the computer, which is coupled with strain gauges in the lower part, takes data at something like 50 times/second and adjusts the flow of hydraulic fluid. I can walk over debris, walk downhill, walk foot over foot downstairs etc without constantly looking down and worrying about falling. I should have said the c-leg is also a hydraulic knee. It is just supported by a computer.
This is hard to explain. To really answer your question though, I have friends with knee and back problems who actually wish they had a prosthetic leg. I get around much better than them.
It essentially allows me to do my job and enjoy life as much as I can, albeit with some limitations. I don’t deserve less than that.
Just because I am an amputee doesn’t mean I shouldn’t enjoy the highest quality of life I can get and the fucking insurance companies don’t understand this.
Say 200 grand over 30 years for a tax-paying contributing member of society. One badly broken real leg can cost that over a few months.
This is a point that the able-bodied are often completely unaware of. Sometimes, due to the current state of prosthetics, making someone an amputee increases their mobility.
Two examples: Oscar Pistorius a.k.a. the Bladerunner and Aimee Mullins, both of whose deformed lower legs were amputated shortly after birth and who prosthesis allow a high level of mobility. If their lower legs had not been amputated both would be using wheelchairs full time and not walking. (Note that both of those people still have “meat knees”, which is a significantly different situation than Klaatu. Aimee has had other people supply her with legs for what are essentially experimental purposes). After a bad accident and a staph infection Lt. Col. Andrew Lourake had his mangled and chronically painful left leg amputated, then returned to flying Airforce Two and the Vice President around the world, something that would not have been possible without a C-leg. He didn’t need to have his left leg amputated, it wasn’t going to kill him, it was just horribly painful 24/7 and he couldn’t walk on it, much less fly an airplane with it. But hey, a C-leg that let him keep his employment and use his highly expensive training is just a “luxury”, right? He should have been content with $3500 towards a low-end leg that just barely lets him walk and requires him to discard all that training and skill for differen work or (due to bias) chronic unemployment, right? How does that make any sense?
The point is, cheap prosthetics make people just marginally mobile. High end prosthetics allow them to function at a level comparable to the able-bodied. In my mind, failure to provide coverage for the high end ones is like saying insurance shouldn’t cover kidney transplants because dialysis will keep you alive if you have crap or missing kidneys. Or maybe if someone needs eyeglasses we’ll pay to correct their vision to 20/100 because, you know, that’s not legally blind but correcting to 20/20 is a “luxury”.
Okay I’m getting confused here. If you can’t sell your old prosthetic leg, how come the people on ebay can?
Or are you using the term “prosthetic leg” exclusively to refer to non-myoelectric prostheses and “c-leg” when you are talking about the kind you’re currently having so much trouble getting?
Also, have you ruled out ebay for obtaining your replacement?
What I’d be interested in finding out is, why can’t it be rebuilt?
This article today reminded me of this thread. Maybe you can contact some of the people and organizations referenced in it to find resources.