There’s something relatively new that keeps catching my eye in TV commercials which is the presence of people wearing prosthetics. It’s a thing these days ya know, diversity. And it’s a good thing, but I’m stopping by real quick to say that in my experience the view that’s being shown looks nothing like what I’m being offered.
I’m talking specifically about the bionic look. The runners knee that’s made by companies like Ottobock. I’ve been a prosthetic user for 41 years and this type of product has never been an option for me. I’ve had various types of insurance coverage and these components aren’t covered services as reasonable and necessary by my plan.
My point isn’t that I could have had an entirely different and more fulfilled life if I’d have qualified for these, it’s more that the general public realize that this isn’t what’s going on in the life of the everyday prosthetic user. It’s TV. It’s basically fiction. But it’s out there attempting to normalize the look of a prosthetic user in a way that’s not an option for most.
Here’s a few things you might want to know about the prosthetics that I’ve had over the past 15 years:
- The gross charges range from 45K-69K per prosthetic
- The insurance determines what components I qualify for
- I have to sign for the leg long before I’m fully comfortable with it
- I can have up to 30% co insurance on the allowable which is in the tens of thousands of dollars, along with deductibles (in and out of net depending on the prosthetic company I chose)
- I absolutely have to make health care decisions based on cost
- I am not eligible for a new one before the current one is uncomfortable (more than the usual) and unsafe
- I am very well insured and these are still the circumstances
The amount the insurance pays has varied over the years from approximately 29K-51K and that’s the amount I can be responsible for 30% of—you do the math!
I can’t pick the exact knee joint or ankle joint that I want. I’m put into a classification based on a form I fill out, my prosthetist fills out and what the insurance company’s medical team believes they know about me determined by this collected data. The have NEVER called me. They decide what I’ll qualify for (read: least amount they could possibly get away with paying for) to function at a level that they determine to be necessary—so that’s fun!
There’s a point in the fitting process in which I have to sign that I like the leg and it’s great (cause all fake legs are great), which usually occurs far sooner than when I’m truthfully comfortable with the product. Many times this works out and I think the credit is all mine because I make it work. But there’s been a few times that I’ve been stuck with a leg that’s not okay and when I say stuck that could be 3-5 years—duuuuuuude!
I covered co insurance above and if you don’t know what that term means in 2019 in America then I’m gonna have to get shitty here and say: shame on you.
Sometimes I prolong prosthetics due to cost, if I have enough work time off to make all the appointments, and even if I’m mentally ready to go through the process. Because I’m high functioning and use the shit outta the thing I usually need a new one — bad. I enjoy running on bald tires waiting for the clock of approval. Totally kidding, I actually don’t.
My husband has great insurance through his employer. While our coverage for regular health care has been outstanding, prosthetics has been very tricky.
I’m way off track. This was supposed to be about not believing everything you see on TV. I wasn’t one of those kids that needed a Barbie with a disability to normalize me. But I do understand in today’s culture we’re making sure that the cross section of human beings is well represented. At the same time that has to be done with accuracy. Showing prosthetic users with fancy components on TV isn’t helpful. If I had to guess it’s leaving many amputees sitting at home a little pissed off. I’ve simply had too much coffee.