I get tired of people with two good legs placing an impediment on being able to walk like it means nothing. Here is an article which speaks to the reality: http://www.usatoday.com/news/health/2007-05-14-amputee-costs_N.htm I am sure you have seen it - if not READ it again - it is still the same story today - and worse. Here's a poignant line from the article: Rick Curran, director of media relations for Blue Cross Blue Shield of Florida, says the company does not cover benefits it considers to be investigational.
The insurer has concluded that the C-Leg doesn't have a benefit over existing prostheses with hydraulic joints. Clearly this guy has two good legs!!! Huge difference in Hydraulic knees and the C-leg - you can EASILY fall on any knee joint - but you have to really work at falling on a C-leg. Stepping off a curb, going down a slight "handicap" ramp, climbing or descending a stair, stepping into wheel rut in a road or parking lot, walking across an un-level driveway - ANYTHING that is not flat and level - and then there is people cutting you off - tripping over your own foot in mid step, and any trip hazard you did not see down there - including any simple ball bearing surface like a cap of a pen or the pen - or even a small pebble.
I had an Endolite Adaptive2. The cylinder blew and it started leaking oil, and lost all support of course. Before it did - I had to really work at falling on it too. It's stumble recovery mode will catch you. A Hydraulic straight - non-intelligent knee will not. You will fall. Although the Endolite hydraulic cylinder is a field replacement part - that can be swapped by anyone who can turn three bolts in and out, they would not sell it to me direct EVEN with a doctors prescription for specifically that part, and when I was forced to contact a prostheticist; the prosthetics company claims it would not sell the part to them either because it was me - without the facility evaluating my prosthetic.
What if my insurance would not pay for this evaluation? AND it would not. Is it their business? NO. Is it their right? NO. What gives them the right to mandate this kind of impediment? A warranty? NOPE . . . nothing can affect the field replacement part not working - but their shoddy workmanship in designing, manufacturing or building it. BUT the reality is - I am supposed to just be stupid and listen to the bull or "experts" with two good legs mind you.
People who can NEVER know what they are talking about - do I care about their credentials? NOPE - not if they have two good legs. I am a man - I can never tell a woman what it is like to be a woman because I read it somewhere in a textbook and put on wig and got treated like a woman for a few days. AND guess what - Endolite knees are known for blowing cylinders. It is a design problem, BUT you get what you pay for - it is a working poor man's C-Leg. Unlike the C-Leg - there is no programming needed by a prostheticist - there are no adjustments - beyond what the bluetooth programmer can be programmed to adjust t the leg to do.
No special parts - no special modes the thing goes into - without the prostheticist - like the C-Leg goes into "native" mode locked up stiff - and you cannot buy or get the Otto Bock software to unlock and program it yourself and save any money. You have to go to an Otto Bock approved prostheticist and have them unlock and program it - cha-ching out of your pocket and into theirs It's bill, bill, bill, bill, bill, for the prosthetic company if you are going to walk again.
The prostheticist will have to mark up for services they were never needed for - and if you have something like I do - where the value of the item is maxed out already to the insurance source- the services requirements push the cost in the red and may bounce approval of it completely. Then what? But what the hell - they have two good legs and walk around everyday. It is shakedown is what it is. The article above - one of the few that speaks the truth - is about how insurance companies place this kind of impediment in your way; and if you are on Medicaid (or a state variant) or Medicare - by the time you can get the knee leg system you need - you are one foot in the grave and you are too inactive to use it - then the prosthetic gets sold on eBay by the Probate Estate efforts when you die with a brand new leg you never used; while others who could have used it - are not able to get one in the first place.
There is NOTHING experimental or "investigational" about a C-leg; it has worked as promised from DAY ONE, and has gotten better the more patients they had to wear them and learn how to improve them. What we have is people with two good legs just deciding - better them than me - and here is place we can deny a valid claim because after all - who will listen and care - no one but another amputee and it ain't enough of them scream loud enough after we have beat them down and they don't have a leg to stand on??? Hah hah hah hah.
Worse - the political and medical systems through which you must go to GET one - do not know what they are doing either. Doctors have no clue what or how to prescribe one - but you MUST get a prescription to get one. prosthetic businesses and prostheticists are not required to be licensed in some states, only insured, (and barely that) ( see http://www.abcop.org/resources/StateswithOandPLicensure/Pages/Default.aspx ) and while they are supposed to see the patient AFTER a prescription is written - often the Doctor sends them FIRST to the prostheticist for what they think the patient should get - and medical issues are then just cast aside largely and doctor learns nothing new about the field.
They think this is the way it is to be done but the Social Security regs say otherwise. The prostheticist often sells what they want to sell - or is on the back shelf or on sale or given to them as a sample that week. For some - it is what they bought on eBay that week - yep believe it. Then they bill the insurance company as though it was new. Happened to me from the largest prostheticist house in the US. YEP - believe it. I mean how many people are beating the door down with business for them? They have to keep the lights on some way wringing blood from a turnip.
This is something that should be added to the Americans with Disabilities Act - not the new Health-care law or insurance policies or programs - but actually into the ADA law where these kinds of impediments are no different than wheel chair ramps and people and companies cannot refuse to sell to you because YOU are willing to take the risks of getting YOURSELF walking again. People should have a right to walk if they want and that should be a "Patient's Bill of Rights"; which INCLUDES prohibiting a company from NOT selling direct to the patient any part they need directly at the same price they would sell to the prostheticist if the patient has a prescription and wants to buy direct. Until most states enacted laws to regulate the Funeral Home business, all kinds of ill-repute went on when the family was over the barrel to bury a loved one.
Frankly even with the laws it still goes on today, but with prosthetics - it should STOP, and law is there to stop it, and all it needs it is few words added that says ". . . or prohibit or inhibit any amputee of any kind from procuring the parts, directly or indirectly they need to regain their mobility" added to the ADA Act. It is institutionalized barbarism is what it is.