Persistence and Prostheses: Pursuing Insurance Provider Approval for Upper Limb Prosthetic Devices

When our patient Kiersten, who has a congenital limb difference, first started experiencing overuse issues in her sound arm and in the shoulder of her affected side, she wondered if a prosthesis could help. “It was my first time asking insurance for anything like this. Both a prosthesis and, say, medication, are prescriptions, but they’re very different things — a prosthetist has to have a prescription signed by your physician for your device. I struggled to get my insurance company to approve my device.”

Receiving a “no” after requesting insurance coverage of an upper limb prosthesis is something many of our patients have gone through. Yet, a very large percentage of our patients have received their prosthesis, following an appeal sent to their insurance company. What is the advice that our current patients have for our new patients or potential patients?

“Don’t let a denial deter you,” Kiersten told us in a recent interview. “Yes, it was a struggle, but I know my body and what it needs best. After speaking with my physician and my prosthetist, I was told that a myoelectric device would work best for me. I wrote letters and made a lot of calls. Being told ‘no’ by a big corporation can be scary. It made me second guess myself, like, 'They said I don’t need it, maybe I don’t?' But I kept pushing. For me, it was a great opportunity to learn how to advocate for myself. There is so much power in patient advocacy. I cannot stress that enough.”