Prosthetic Limb Upgrades Can Take Work With Insurance

SAN FRANCISCO (CBS SF) — Technology has led to huge advances in artificial limbs, but for many patients, the quality of their prosthetic depends on their insurance.

One Bay Area woman has turned to ConsumerWatch for help.

Pinky Cruz does as much with one hand as most people do with two, but it’s not easy.

“People just don’t appreciate things until you lose it,” said Cruz.

One problem? Her seven-year-old prosthetic isn’t exactly state-of-the art.

“It doesn’t do anything. It’s just something that you can use on so it won’t show you have a disability,” explained Cruz.

So the long-time airline employee asked her health insurer for a newer bionic model.

Her Kaiser plan entitles her to a replacement every five years, so Cruz is essentially two years overdue. But her insurance did not want to replace the outdated prosthetic with more modern technology.

They prescribe me the same one. I want something more functional, said Cruz.

She asked for a second opinion from a different Kaiser doctor who approved the high-tech hand she wanted from a company called bebionic.

But she says, despite numerous calls, Kaiser simply stopped responding.

“I just never received any communication from them,” said Cruz.

She says when she filed a grievance with the insurer, she was told the process would take even longer.   

That was when Cruz called ConsumerWatch. Gerald, a ConsumerWatch volunteer, was happy to lend a hand.

He reached out to Kaiser and, within a few days, a letter from the insurer finally got back to Cruz to approve her request.

The letter read: “We deeply regret that we did not meet your expectations and will use your experience as an opportunity to learn.”

“I was crying because I never thought it was going to happen,” said Cruz. “All my life, I wanted something for my left hand so that it will function the same as my right hand.”

Cruz expects to get her new prosthetic next month. Kaiser would not comment on the case, but said it regret any concerns or confusion a member experiences and are committed to quickly resolving issues.

If you feel you’ve been unfairly denied treatment by an insurer, you should immediately file a complaint with the state Department of Insurance.

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