Re: C-leg approval

Posted by Casey on September 07, 19104 at 12:40:40:

In Reply to: C-leg approval posted by Bev on September 06, 19104 at 15:18:38:

I wasn't turned down for that reason, but for a similar reason.

First you need to get your company's definition of Deluxe and Standard.

This article provides an argument:
http://ottobockus.com/products/lower_limb_prosthetics/c-leg_reimbursement_information.pdf

But, use your own reasoning, too.

I think reasons establishing medical necessity should overide these general rulings.

I suggest you appeal unless time is a factor. The process can take months. It depends on your situation. If you are in need of a prosthesis now, that may not be an option for you. Talk with your prosthetist and doctor about your options.

: I was just turned down by my insurance Regence/Blue Shield for a c-leg as being a "Delux" model and they only supply a standard leg for daily activities. Has anyone had this reasoning and been able to successfully appeal? What should I do? Bev

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