A Colorado man's experience highlights the disparity in health insurance coverage for prosthetic limbs compared to joint replacements.
Michael Adams, a 51-year-old amputee, faced a frustrating situation when his health insurance plan refused to cover the replacement of his prosthetic leg. Adams lost his right leg to cancer 40 years ago and has relied on various prosthetics over the years. His current plan, purchased on the Colorado health insurance marketplace, initially covered prosthetics, including the microprocessor-controlled knee he used.
However, when he needed a replacement last January, the insurer deemed it not medically necessary, despite Colorado law leaving the determination to his doctor. His doctor has prescribed a similar leg for many years, even when he had employer-sponsored coverage. Adams argues that the electronic prosthetic knee is life-changing, providing stability and fall prevention. He highlights the disparity in coverage between joint replacements and prosthetic limbs, noting that people undergoing joint replacements rarely face similar issues.
Health Insurance Prosthetic Limbs Coverage Disparity Medical Necessity Amputee Community
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