Jun. 16, 2025
If you've been shopping for new coverage lately, you may have noticed that a lot of insurance policies have very low limits for prosthetic coverage. On top of that, it's pretty common that your copay goes up as the cost—and function—of the component increases. Insurance companies often want you and your medical team to compromise, i.e., opt for a less costly component that they're willing to pay for. So how do you get the most functional prosthetic devices without having to pay more out of pocket?
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Sometimes your physician or prosthetist will also be your advocate. A doctor's letter and progress notes may convince the insurance company to pay for a more expensive component, or that the chosen hardware is the best suited to your medical needs.
But while your prosthetist will fight for you, you're the one paying the premium. Once you know which features are absolutely necessary and will benefit you the most overall, use these strategies to contain the cost of your prosthesis without having to compromise function, quality, or comfort.
Traditionally, the first prosthetic device you wear is temporary. You wear a preparatory prosthesis while your residual limb matures and changes shape following amputation surgery. After several months this temporary prosthesis inevitably becomes ill-fitting, at which point you'll be fitted with what's called a definitive prosthesis. Insurance companies only allow basic components for a preparatory prosthesis and they're more likely to cover higher end components at an earlier stage when receiving a definitive prosthesis and skipping the preparatory prosthetic phase.
Many prosthetists may argue that the benefits of going straight to a definitive prosthesis are two-fold when you're a new amputee. Not only are you exposed to more advanced components through a definitive prosthesis, but you may also avoid poor walking habits from using less sophisticated components early on. You'll also have the option for a foam cover, a component that wouldn't be covered with a preparatory prosthesis.
Note: One disadvantage if you're fitted for the definitive prosthesis right away, without a preparatory trial, your prosthetist will have to make an educated guess about which components you'll benefit from most. Without any historical use information, the potential for over or under providing exists, because it can be difficult for prosthetists to predict the future version of you. With that being said, if you have a share of the cost, doing it this way can save you money of the total cost of prosthetic care—one temporary and one definitive—versus a definitive and one simple socket change.
In terms of cost of knees, there are 3 categories: friction-controlled, which is ideal for one-speed walkers and is available at the lower end of the price range; fluid-controlled, which is perfect for fast walkers and those that frequently vary their speed; and microprocessor, which is ideal for people with diverse functional abilities and is also the most expensive.
It's been found that certain popular knee features, like a manual knee lock, will add to your bill. It's important to understand what each feature does and whether you'll receive any benefit. When picking features for your prosthetic knee, ask your prosthetist which prosthetic knee will suit your needs today as well as into your future, preferably around 3-5 years down the road.
For more expensive components, trial periods offered by manufacturers can serve as additional evidence whether this is the right component for you, information that may influence your insurance company. Some manufacturers offer prosthetic feet and knee units that have a 30-day return window, for example. And if you do, you and your prosthetist will be more informed about the device's potential benefit, and better equipped to lobby the insurance company on your behalf.
If your insurance company refuses to cover or authorize what your prosthetist is requesting, he or she will help you navigate the world of health insurance, which may or may not involve using different components.
To prepare the most convincing insurance claim possible keep a medical journal. Document any abrasions, blisters, or ongoing discomfort. If your gait or sense of balance have been negatively affected, you've fallen, or your mobility has been limited in some way by the prosthesis be sure to include those details in your claim or prosthetist's "letter of medical necessity." Record the dates of any doctor visits related to your issues. If your claim is initially rejected use the appeals process to fight.
Remember that you're the patient and you have a voice and rights. If your health insurance company isn't supporting your needs and paying for the appropriate prosthetic care, it's critical that you appeal their decision and go through their appeals process. In extreme cases, sometimes the option to change health insurers exist, and it's something to consider.
Before you commit to a new health insurer, make sure you understand your health benefits and coverage when it comes to what the company will or won't cover, like medical equipment or what they consider as being "experimental." Figure out the co-pays and your future out of pocket costs. Understand how to file an appeal. If you're covered through your employer's insurance, check with your employer to see whether other health insurer options are available.
More than 80% of Americans research health-related topics online. Around 20% of people look up specific hospitals and doctors. Most people tend to do their homework when it comes to picking a doctor or a hospital. The same needs to be done for a prosthetist.
After all, a prosthetist is there to help you regain your mobility, stay active, and take care of your body. Not to mention, prosthetics need to be regularly checked and maintained in order to function properly. That’s why picking the right prosthetist is such a delicate process.
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Today, we’re going to talk about:
Here’s what you need to know…
Let’s start with the most obvious question: what does a prosthetist do? Of course, you already know that it’s the person who makes prosthetics. But is that all? Not at all. They’re also there to give examinations, talk to patients, and advise them on how to take care of their prosthetics.
While different prosthetics providers offer different things, you should look for:
Some prosthetic providers don’t actually make their own devices. Even if that’s the case, you should look for someone that has a good relationship with the manufacturer and that can have them make corrections in a timely manner.
Medical devices like prosthetics and orthotics can’t be taken lightly, not by the patient or the prosthetist. That’s why, the first time you go and visit one, you need to have questions prepared in advance. A good prosthetist will have the will and patience to answer all of them.
Once you do your research online, you’ll be able to narrow down a couple of prosthetic providers. Make a list, contact them one by one, and conduct interviews over the . Some of the more important questions you should ask include:
We talked about the qualities a prosthetist should have and the questions you need to ask them. And now, let’s see what are some of the things you need to ask yourself. Here’s what you need to know before selecting your prosthetist….
The level of your amputation affects a lot of things. In case your leg has been amputated above the knee, then, joint movement of the knee and ankle is important. Above-knee prosthesis takes longer to design and build. Also, it might require more adjustments in subsequent visits. The same goes for above the elbow amputations. The more severe your amputation is, the more complicated the entire procedure will be.
Not everyone has the same priorities. While some people love to exercise, others don’t care too much about it. So it’s your choice if you want to look into sports prosthetics that will help you with your performance or if you want a realistic-looking prosthetic. A prosthetic that will help you run won’t be aesthetically suitable for a night out and vice versa.
As we keep saying, a prosthetic limb is a tool. That’s why your choice heavily depends on your aspirations. What are some of the activities you’d like to take part in? Do you want to go out running or do you enjoy walks more? Do you have any ambitions of competing in a sports tournament at any point in time? Ask yourself all of these questions before visiting a prosthetist.
The office should be near you for a number of reasons. For instance, if you’re just learning how to put on a prosthetic leg, it’s far more convenient to have a medical professional around the corner than a few hours away. In this situation, traveling long distances isn’t convenient at all. For that reason, you should look up local offices first. Only if you’re not satisfied with their offering or services, should you start looking further away from your home.
The last important dilemma is how much money should you spend on a prosthetic limb. If you’re looking for performance and endurance, you’ll have to spend more money. For example, carbon fiber prosthetics cost a lot more than plastic ones. If you don’t have insurance or enough savings for an expensive prosthetic, you can start with a less advanced one at first. Then, when you save up some money, buy a high-quality one.
Picking the right provider is crucial when it comes to having a prosthesis designed and manufactured. Your prosthetist will fit you with a tool that will allow you to live comfortably for years, if not decades — a tool that will give you the lifestyle you want.
Even though having a local prosthetist doesn’t always equal quality, you should look for providers near you. If you live in Wisconsin and you’re in a need of a good prosthetist, you should look no further than Align Clinic.
The company is the world’s best orthotic knee joint supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.
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