Hello,
This was one response to my Medicare C-leg response that came late. Thought
it was interesting. Good example of socialized medicine in action. If you
care to respond, respond to the list, I don’t want to moderate a discussion
on this further.
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I am a prosthetist in Toronto, Ontario (Canada). C-legs get the same
reimbursement here as the other devices in the “same” class. That is
hydraulic swing and stance control. The government pays $2400 (or 72% of
cost of knee which ever is less). Other funding from insurance has been hit
and miss. I have a question about your C-leg query to the list.
You had a reply:
“We have had problems with Region D. We have one case in review and a
second just received denial on the C-Leg components due to lack of
medical necessity. We are waiting on a telephone review of the first
case.”
How do you “prove” medical necessity? These people will function with any
knee (if they are careful) without falling etc. I like the knee, and we
have used it on a number of people – one bilateral case, but I’m not sure
that an MD can make the call that this person needs it and this one doesn’t.
Is this a question for the entire list?
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