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Amputee ~vs~ Insurance Company

In my last blog post Diabetes and Amputation I revealed how I became an amputee. In this blog post I will relate to you how the insurance companies working in conjunction with prosthetic companies have a mission of hindrance when it comes to an amputees mobility. I’ll start with the K Test.

The K Test is how prosthetic companies decide what version of a prosthetic limb you are eligible to receive upon reaching the moment when you’re ready for a prosthetic limb. This test has four levels. Level 1 is just a peg leg. Seriously you get a wooden foot with no ankle and a metal rod leading up to the prosthetic socket that holds your limb. I kid you not. It makes walking and mobility damn near impossible for any new amputee.

Level two is not much better. Level 2 of the K Test means you get a foot that may make your mobility eaiser…. But in most cases it’s just one level above the K 1, which makes walking a hindrance. I mean let’s be honest, after years of walking with an ankle that actually works and aides in your mobility, having no working ankle is a big adjustment. Being a brand new amputee, there should not be a system in place that makes mobility harder as you begin this journey. Everything should be done to make your transition into being an amputee and continuing with your mobility, easier. That is not the case.

The K 3 level is a little bit better. You get a more technologically advanced prosthetic. Level 4 of the K Test is the golden ticket. If you test at a K 4 level you are afforded the most advanced technological prosthetic socket and foot available. That means you get computer chips, roboticized sockets, feet that actually have working ankles that flex with each step…. Like a normal flesh and blood ankle. After 2 years of dealing with insurance companies working in conjunction with the prosthetic companies I discovered that insurance companies have these test levels in place to prevent new amputees from getting the equipment they need and making a smooth transition into life as an amputee.

After 3 years of dealing with insurance companies working in conjunction with prosthetic companies, I discovered that it’s all about the bottom line…..the financial bottom line of the insurance companies. These sockets and prosthetic limbs, feet, ankles cost upwards of $15,000 per unit. The cheaply made prosthetic limbs that you get at the K 1 and K 2 levels cost a fraction of $15K. I also found out that an insurance company would rather not pay for an expensive prosthetic limb if you’re not going to use it on a regular basis. Like everything connected to an insurance company, insurance companies strives for the cheapest solution possible.

Back to the K Test. My first K Test I tested as a K 2. I was forced to take this K Test using a walker and no socket whatsoever. My limb was wrapped with after surgery bandages and I was forced to take my K Test for mobility using this walker. I had never used a walker in my life. So of course walking over a obstacle course testing my mobility with a walker was a failure for me. Two months later I retested. And this time using a K 2 prosthetic limb, I tested as a K 4. One of the happiest days of my amputee life because I thought, now I could get the most technologically advanced socket available.

I was sadly mistaken. Insurance companies denied my request for the most technologically advanced socket, foot and ankle combination available to me as a K 4 level amputee because there were warranties on the equipment I got initially. The warranty said I wasn’t eligible for new equipment, I couldn’t get any new equipment until the warranty expired, on the equipment I initially received, which is 3 years or 5 years depending on the model. The insurance companies had this warranty in place to prevent people like me who upgraded their K Test level, from upgrading to better equipment. I appealed this decision by the insurance company and won my appeal. So I was able to upgrade to a K 4 level foot.

It took me two and a half years to do something that should have taken me a month to do. Getting the proper equipment that you need as an amputee to even get a tiny bit of normal mobility, shouldn’t have to be a fight with an insurance company. And the prosthetic company that makes your equipment should be on your side, and not helping insurance companies make being an amputee, and being mobile, difficult. This coming January in 2023 will be my 4 year anniversary as an amputee. In this time frame I have been in a constant battle with the insurance company over what my mobility needs happened to be and getting those needs met by insurance companies who have to approve every single piece of equipment.

When you’re an amputee, no matter how long you have been an amputee, you shouldn’t have to spend your time stressing out, worrying, fighting to get the equipment you need to be mobile every single day. The wrong socket fit means every step you take you question whether it will be your first step that makes you fall on your ass. Confidence in the equipment you have is vitally important. When an amputee takes a step it’s not an automatic action. People who are not amputees and who have both their limbs whether it be lower limbs or arms, have to think about what they do. When you have your normal god-given limbs your brain sends the signal to your actual limbs to move, it’s not something you have to think about. An amputee has to think about every step they take, every movement they make with a prosthetic.

My point being I shouldn’t have to fight with my prosthetic company or my insurance company about what equipment I am eligible to have. I should have the same equipment that an Olympic athlete has. I should have access to the same equipment as somebody has who has wealth. My mobility is as important to me as someone with of millions of dollars who can afford to buy their own prosthetic equipment.

In the next edition of these blog post about being an amputee, I will address the pitfalls to avoid, things to look out for as a brand new amputee. I will give some advice on what things I learned that may be able to help you avoid frustration with getting the equipment that you need…. To be mobile and have a semblance of a “normal” mobile life.

As always in closing thank you for reading Just Another Blog by Me, Just Another Blogger.

Published by Just Another Blog

This is just another blogger with just another blog. "This is not the blog you seek." πŸ€”πŸ₯ΊπŸ˜…πŸ˜† I'm very lazy about blogging, I only really blog when something gets under my skin. I have very thick skin. Thank you for reading this blog, but maybe you shouldn't waste your time reading this world.

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