This afternoon we took Jonathan to a fitting for his prosthetic leg. As the doctor was fitting the prosthetic on to him you could tell this was a proud moment for Jonathan. He was able to stand on his own 2 feet and have his hands free!
Jonathan was able to walk holding on to the bars using his new leg!
Learning to walk is hard work!
We will get a call in about 2-3 weeks and then we'll go again for (what should be) the final fitting. If all goes well we will come home with a leg at that time and begin physical therapy.
At the end of our appointment, we had an unpleasant surprise. We were informed that our health insurance denied the claim to cover the cost of Jonathan's prosthetic. Apparently, our health insurance does not think a prosthetic leg is "medically necessary." Now, Shiner's Hospital is a charitable organization and the way Shriners works is that we will never get a bill from them. But, they will submit claims to our insurance as needed and they will pay whatever is not covered by our insurance. In this case, they will still go forward with the prosthetic at no cost to us, but they did ask that we appeal to our insurance company to cover the prosthetic. We have started the appeal process and our appeal will go before the appeal board of our health insurance for review. Please pray that they reconsider and pay for Jonathan's prosthetic.
I mean, it is great that Shriners will absorb this cost for us. But many Shriners patients are under insured or uninsured... and it seems wrong for this reasonable claim to be denied.
I understand that Jonathan can live a happy, healthy life with one leg, but where is the compassion here? He needs and wants a leg! We are going to fight this because we do not think it is right that the claim was denied. Also, if we're not successful with our appeal, we will be limited to where Jonathan can get physical therapy because that too will not be paid for by our insurance. There is a ripple effect to this first denial!
It's tempting to respond in anger and push "hot" buttons. Health insurance is a politicized hot topic if ever there was one! But, we're going to play it cool for now. We hope our insurance company comes to its senses. Ultimately, we believe God is in control and that in the end Jonathan will have what he needs.
That is incredible. How can it not be medically necessary?
ReplyDeleteI'll be praying about this issue.
Jonathan looks great with his new leg!!!!
I am a mom of 2 sweeties from China as well as an OT working with Adult amputees in Canada. I do a lot of prosthetic gait training. I am simply flabergasted that your insurance company finds that a prosthesis is not medically necessary. Are they waiting for him to develop problems with his shoulders, elbows and other hip? I hope that you are successful with the appeal. If you need any ideas, I would be happy to help. (imanot@sympatico.ca)
ReplyDeleteJonathan looks great with his new leg.
Thanks for the prayers!! It was interesting yesterday when Jonathan was trying to walk with the leg and his crutches the prosthetist guy said he was using the crutches as a bad habit b/c he was dragging the prostetic leg instead of lifting and walking. The longer he uses the crutches the harder it will be to break these habits. Praying we get approved with the first appeal. I really don't feel like fighting health insurance.
ReplyDelete