If you are an amputee who wears a prosthesis, you probably know the drill. Your limb no longer fits well and is beginning to feel heavy. You explain the problem to your prosthetist who says it's time to replace and update the limb. Your prosthetist explains how improved componentry and better prosthetics technology will help make you more functional and independent. Now you understand the need for an updated prosthesis.
Some larger companies employ agents who routinely process all prosthetic claims.
This is to your benefit since they are familiar with an amputee's needs and prosthetic systems. But not all insurers are large and have informed staff. However, a payor's refusal to approve complex new components often results more from inadequate knowledge than from a desire to deny a necessary device. Usually, if a claim is denied, it happens during application for prior approval. If your request is denied, tell your prosthetist immediately so the insurance carrier can be contacted as to what additional documentation is needed to process your claim.