Most people never imagine needing a prosthetic device and therefore never read the fine print on their health insurance policy. But as Good Morning America aired, health insurance companies usually balk at paying for expensive prosthetics. Susan Bailey, wife and mother of two boys lost her legs right above her knees due to an E. coli infection that spread to her legs. While she lay in a two week coma, her husband approved the amputation in order to save her life.
After the ordeal, she went home with a pair of "cheap" prosthetics, the only ones her insurer would approve. After falling around the house and yard just to complete everyday mundane chores, she learned of a prosthetics manufacturer that developed the "C-leg" made specifically for people like Susan with leg amputations right above the knee level. The cost for this model is around $100,000 per pair and her insurer denied her claim and appeals.
Eventually, Ms. Bailey obtained her C-leg prosthetics after her state's insurance regulator overturned her insurer's decision.
Insurance policies contain numerous exclusions. Read and know what your policy covers and doesn't cover. According to the Amputee Coalition of America, insurance companies routinely deny the more "expensive" prosthetic models, even the less expensive models that can cost around $12,000.
You can reach Miami Insurance Claims Attorney J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email J.P. directly at [email protected].