Well, as I approach the time where I'm ready for my new prosthesis, I'm becoming familiar with an insurance term that I already see is going to cause me grief. That term is "Medically Necessary ". In order to receive the prosthesis that will allow me to perform NEAR my pre-accident ability, my prosthetist has to translate my input to an insurance language that will show them that I am limited by my present prosthesis. At the same time, he has to demonstrate to their satisfaction that the more advanced prosthesis WILL allow me to perform more closely to normal . But proving what I WILL BE able to do is difficult because I can't do it now. And how does my prosthetist and I prove that the new leg will allow me to perform more tasks since I can't perform them now?
Insurance logic. If I can perform the tasks now, I don't need the advanced prosthesis. If I can NOT perform the tasks now, why do I need an advanced prosthesis that I can't fully utilize?
Quality of life means nothing to them. My prosthetist told me that he needs to use words such as pain, imbalance, unstable, and about to fall in order for then to pay attention. The fact that I could run and jog prior to my accident may mean little to them.
Imagine being able to overcome nearly every physical and mental hurdle only to be blocked by an INSURANCE COMPANY and semantics? Oh well. With God's help, I'll overcome the insurance bean counters too. Hopefully by June, my prosthetist and I will have come up with a Winning strategy.
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