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Post by texas9red on Aug 7, 2017 13:44:59 GMT -7
I am AKA on the right side. I was of course very sick and weak in the hospital. Right after I got out of the hospital I only weighed 120 lbs. Now I weigh 180 lbs. I have always been on the heavy side. Needless to say I cannot use my prosthetic anymore. There is no possible way I can go back to being close to 120 lbs. I feel great. I am strong and I have maintained my exercises. I feel like me again. I am getting BCBS next month. I got my leg last December 2016 with other insurance. Does anyone know how long I have to wait to have the possibility for a new fitting to get a new leg in the future?
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Post by cherylm on Aug 8, 2017 3:28:48 GMT -7
It's not unusual for a new amputee to need more than one prosthetic socket in their first year...although more often it's because the residual limb/stump has gotten smaller due to natural shrinkage. Check out the Durable Medical Equipment (DME) coverage on your new insurance plan and see if they specify any time limits or dollar limits on prosthetic coverage. Then see if your doctor or prosthetist can put in a request for a new socket due to your size change. You might have to get them to justify your size gain and the fact that you now are at a stable weight...not fair, but it might be an issue. And once you have that wearable leg, you'll most likely find your limb starting to shrink, even if the rest of you remains stable...meaning more adjustments, padding, new sockets, etc..............
Your first year or two, you'll be amazed at how much time will be spent "tweaking" your leg...but it will be worth it!
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Post by snowyh on Aug 8, 2017 15:48:27 GMT -7
Hi, Christina. Go to the same prosthetist you went to before, if you were pleased with their work (and they accept BCBS). Show them your new insurance card and ask them whether a new socket would be covered. I'm sure the majority of their business is making new sockets when the old one no longer fits well, and of course they'll want your repeat business! They likely know exactly how to word the claim so that it's most likely to be paid. Either way, my guess is these guys won't do any work unless they've either verified that your insurance will pay or they get a deposit from you, so there shouldn't be any surprises. I'll bet it'll be covered no problem, and if not, they'll be able to tell you exactly when to come back. Remember, they're on your side--the new socket will benefit both you and them.
Helen
PS--I don't wear a pros myself, so I may not know what I'm talking about here. But I've been to plenty of doctors and had more than my share of tests & operations over the years, and never had a claim denied.
PS2--I hear it's common for insurance companies to deny costly claims the first time they're submitted. But you can appeal the decision and the majority of denials that are appealed ultimately get approved. Good luck!
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