Are Lower Limb Prosthetics Covered by Medical Insurers?
Employer Plans or Independent Health Coverage Plans
In most cases, medical insurance covers at least part of the expense of a prosthetic limb.
How much coverage you get through an employer's medical insurance for an artificial leg depends on the company, the plan, and a number of other factors.
Some plans pay for everything as long as it's considered medically necessary and after you've met your deductible or covered your copay or co-insurance. Others put limits on how much of the bill they'll pick up. Or they'll limit how often you can replace damaged or defective devices.
A prosthetist bills the medical insurance provider, not only for the device, but also for the proper fit and alignment, all as one total cost. Proper fit and alignment may require several trips to the prosthetist's office.
Medicare Part B
Medicare Part B covers prosthetic devices needed to replace a body part or function when a Medicare-enrolled doctor or other health care provider orders them.
For Medicare to pay for your prosthetic device, you must go to a Medicare-enrolled supplier. This is true no matter who submits the claim (you or the provider). Visit Medicare.gov for more information.
Medicaid will cover the cost of an artificial leg due to a disability if a physician or healthcare provider states that it's medically necessary.
According to the Kaiser Family Foundation, every state offers prosthesis coverage as a Medicaid benefit even though doing so is optional.
Medicaid programs don't all cover prosthetic devices in the same way or to the same extent. The best way to see how your state handles this kind of coverage is to contact your local agency and ask about it.
What if You Have Out-of-Pocket Costs You Cannot Afford?
Blatchford offers an extremely helpful solution for all patients needing money to pay for their lower limb prosthetic device. The program is part of Blatchford's Patient Access Powered by Repatient.
The cost for a prosthetic leg can range anywhere from $5,000 to $50,000. Getting an insurance company to approve the cost can be challenging at times.
All patients should get the lower limb prosthesis they need when they need it. Blatchford's Patient Access Powered by Repatient offers a free service that will make sure this can happen.
Blatchford is Committed to Helping Every Patient Get the Prosthesis They Need
Prosthetists are required to collect reimbursement from the patient at or before the time of providing a prosthesis. While up-front payments are understandable, patients that cannot pay or will struggle to pay, often postpone care, believing that they have no other option.
Clearly, out of pocket cost is a factor for both patient and clinician.
Blatchford’s Repatient program makes paying for healthcare easier for patients by providing interest-free financing for the patient’s deductible while paying healthcare providers up front.
Patient Access Powered by Repatient offers flexible terms for all patients and has no patient denials.
We are working every day to bring this solution to O&P clinics across the United States.
The Blatchford Community
For over 130 years Blatchford has designed and produced some of the world's most advanced artificial limbs and mobility solutions.
INTRODUCING Elite Blade
- Ideal for cross training, running, bat and ball sports
- Controlled acceleration and deceleration
- Ease of alignment incl. A/P slide
- Variable spring stiffness heel wedge
- Heel stiffness adjustment