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-   -   Any amputees out there? (http://birthmark.org/board/showthread.php?t=3758)

June23rd2010 03-21-2010 04:55 AM

Any amputees out there?
 
After 27 years of living with a severe unnamed (officially) vascular condition affecting my left lower extremity and including my left hip, genitals, lower back, kidneys etc.. I finally got in to see Dr. Driscoll at the Mayo Clinic and he diagnosed what I thought to be KT Syndrome as Servelle Martorell Syndrome. And after many years of being told that amputation was my best course of action but that no doctor was qualified to do so unless it meant saving my life in an emergency situation, Dr. Driscoll, Dr. Sim and Dr. Gloviczki agreed to do it. My amputation date is set for June 23rd 2010. Believe it or not, I AM looking forward to it.

My fear though is that my insurance company will not approve me for the c-leg and instead will only approve me for a more traditional leg whereas I truly do need the versatility and control that a c-leg can offer. I have Aetna and their policy specifically states that as long as the amputee is otherwise healthy and active and who'd daily activity level warrants such a device it would be approved. However there is an "unless" mentioned at the end of their policy that reads something like "unless the amputation is a result of a vascular condition" - Well there is the kicker huh?

You see, I am "otherwise healthy and active" I am turning 27 in June, I have 3 children whom I care for almost solely because my husband is in Iraq and will be there until next December as a contractor. Even after he returns he travels several times a year for up to 6 weeks at a time. Our children are currently 1, 3 and 5. Prior to my most recent injury I enjoyed rollerblading and dancing as well as riding bikes. I'd love to teach my children all 3 of those things. I also have 2 dogs I spend a good bit of time playing in the yard with and I have a long driveway with steep incline which another type of prostheses might not be able to handle. Not to mention I live on an acre with a very uneven backyard and a 45 lb tortoise I have to carry to a shed on cool evenings. - Needless to say, I REALLY need that c-leg. I am terrified that Aetna will not approve me for it based on this vascular stipulation.

I am hoping someone here will have some advice for me or have Aetna and can give me hope in the form of experience with Aetna approving their c-leg.

I hope to hear from you. Feel free to e-mail essarybunch@gmail.com

Thank You!

Laura

missy 03-21-2010 02:05 PM

Please go to http://birthmark.org/experts.php and start a dialogue with Basia, our insurance rep. You need to get together the things you need now and be prepared (you know that, though) and she can possibly help you.

Why the vascular stipulation? Do you know?

Is your husband military? Could you possibly get it through them?

Any idea of the cost of a c-leg?

Otherwise, hi and welcome!!

Missy

abatie 03-22-2010 05:24 PM

Laura,
I see that you are doctoring with Mayo. I am almost positive that they have people in place that can help you through the insurance stuff and may be able to communicate with your insurance prior to get the approval. We doctor at Mayo too and I know that somewhere in their huge maze of information I saw something about this. I am guessing you are being seen through Gonda Vascular Center-right? My daughter hasn't been apart of the center but has seen doctors that work there. She is seen on the pediatric floor instead. Just a suggestion.
Alison


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