1mo ago

Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity

kffhealthnews.org Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity - KFF Health News

Advocates say it is discrimination and are arguing for “insurance fairness” on the grounds that people who have joints surgically replaced typically don’t face the same kinds of coverage challenges.

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1mo ago

Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity

kffhealthnews.org /news/article/prosthetic-limbs-private-insurance-coverage-denials-amputees/

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I have a friend who has a prosthetic. Sure they could live their life in a wheelchair. But this guy goes hiking, and acts like a fully capable walking person. The quality of life is huge. It really gives back their life.
- Yep. It’s absolutely insane they wouldn’t cover it.
  It’s honestly unethical as shit.
  
  Unethical and counterproductive. Having a prosthetic limb would almost invariably lead to a less sedentary lifestyle, which is strongly correlated with better health. Paying for a prosthetic today has to be cheaper than paying for a heart attack or diabeties later.
  
  Yes, but who cares about later if there are quarterly and yearly profits to get.
  
  You're making the assumption that they'll pay out for a heart attack or diabetes later. You just said that they were caused by the pre-existing condition of not having a prosthetic limb.
  
  What makes you think they will pay for heart surgery or diabetes later.
  
  Depends on how you measure productivity. The hope is that by the time long term care is required for things like diabetes or heart disease, the patient would be eligible for Medicare.
  That or the sedimentary lifestyle will so negatively affect the more than likely diabetic patient, that they go into renal failure and qualify for disability through social security. Effectively removing their cost onto a socialized network.
  Paying for a prosthetic is much cheaper in the long run, but not for private insurance. The vast majority of the cost of not providing a prosthetic will be absorbed by Medicare.
  
  But being unwell is profitable
  
  Won't somebody thinking about the profiteers?
  Those guys can go to hell
  
  It's absolutely insane that people should be expected to either buy insurance or pay for medical care out of their own pocket. And the insurance is never enough.
  
  I mean it’s not really. They don’t cover hearing aids or even implant surgery. “Not necessary” is what my sister gets told. Yeah, trying living deaf you asshats!
- They are saying it’s not “medically necessary” to have any quality of life. As long as you’re breathing, you’re A-okay in their book.
  This is what insurance in the US has come to mean.
  
  Like how they still consider dental care to be "cosmetic." They'll rip them out of your head free of charge, but putting new ones in? No sir... You can eat mush!
  But God forbid anyone mentions a solution that includes socialized healthcare...
- From a purely "medical necessity" viewpoint even, having a properly-functioning prosthetic helps him keep the rest of his body healthy! (Although I suppose they'd figure on denying claims for hospital treatment when his unhealthy heart caved in!)
  
  (Although I suppose they'd figure on denying claims for hospital treatment when his unhealthy heart caved in!)
  The long term goal of this type of policy is to not only reduce immediate cost, but to offload the cost of long term care onto a socialized network like social security.
  The majority of amputees are already diabetics, if you remove their ability to remain active and mobile, you substantially increase the chance of renal failure. Patients who require dialysis because of renal failure get enrolled for disability through social security.

111 comments