I received an email from a person asking a couple of good questions which go something like this:
"How does insurance pay for elective amputation?"
"If I don't have a local surgeon, who would I recommend?"
I am not an expert on insurance, and go only go by my and others experience(s). My doctor submitted my case to the insurance company and they approved it as at least two others I am aware of since my operation. My blog outlines what I went through before my amputation. I could have undergone many more surgeries at great cost to the insurance company without any relief whatsoever; as I've noted, I didn't really hold out great hope my first surgery would work to allow me to run again or even have a tolerable pain threshold.
Also as I've mentioned, others have gone through many surgeries without success, success meaning having a healthy foot, one that would allow activity without pain. So it would make some sense for the insurance company to pay for the single amputation rather than a multitude of other surgeries. They would save money and the person would return to a more normal lifestyle. I know of two amputees who went through 16 and 26 surgeries each, how is this "better" when the surgeries do nothing to improve or restore the quality of life, only serves to keep a non-functioning and painful limb intact?
One issue that must be considered is the cost of prosthetic feet, which can be costly. Still, an insurance company that is saving a huge sum from stopping the unnecessary surgeries could provide a better benefit for prosthetics. The rub here is some insurance companies provide minimal amounts for prosthetics while others provide for a fair amount.
I think for many people sight is lost about what insurance companies do provide, they think "I pay X dollars a year in premiums but I demand X * 2 dollars in benefits." Different companies - if allowed to compete fairly - will try to offer a wide range of benefits and price points. But without a doubt parity should be given to amputees, same as say, heart patients. Here is what my current insurance company provides for the prosthetic device benefit: "$2,500 per year and are limited to a single purchase of each type of prosthetic device every three years."
No definition is given they mean by "each type of prosthetic device" although it seems I quality for one $2500 foot every three years. This would give me something like this and I am NOT being entirely facetious:
Wooden leg of Gen. Józef Sowiński (Image by Halibutt 8/3/2006)
Our previous carrier had what I thought was a fair prosthetic amount of $8000/year. However, given the rising costs and the fact real competition is denied in the United States - oh the irony - my company had to change providers. This is certainly a subject all its own and one the American people spoke on, but were given a boot to their collective throats.
I would like to add I was prepared to have to buy my running foot out of pocket, not because my pockets are full, but because running is my sport and passion. Some guys like to fish and spend tidy sums on boats and associated equipment like beer coolers. My sport is running and a running prosthesis is my required equipment. Hello Jato.
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Had insurance not paid for my operation I might have had to look at doing it out of pocket. I already considered that I might have had to pay an exorbitant amount for prosthetics, but I did not fully investigate what it might cost me if I paid for the operation myself. One surgeon who was not on my insurance network said they would work with me on a payment schedule for any difference in cost, but once I found my local surgeon I did not need to consider this further. It is possible, given all these costs, that unless I received some significant help outside my realm that I would not be writing this now...I'd be loopy on pain meds while my life disappeared over the smoky horizon.
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Anyone looking at elective foot amputation - especially to return to an active lifestyle - must have the Ertl procedure done in my opinion.
Ron King currently is the webmaster at this excellent site for information about this procedure here. If you go to the "Ertl Pages" on the left column and then click on "Ertl Surgeons" the top of the next page you can find a list of physicians who perform the operation here in the US. This is not a comprehensive list of all surgeons who do the procedure, but certainly one to help get you started if you have no local doctor available.
I certainly recommend my surgeon, Dr. Blake Ohlson. A surgeon I talked to while researching the Ertl procedure in Virginia was Dr. Joel D. Stewart; my CP has seen him do the operation and was very impressed with his skill. Dr. Ohlson's mentor was Lew Schon, MD who can be found on the aforementioned Ertl pages. I've also heard good things about Dr. William Ertl through Ron King. I recently read an article about Dr. Douglas G. Smith found here.
Whoever you choose, you I think you need to feel a good chemistry with your surgeon. You should never be made to feel you are dumb for asking a question. Having confidence and a positive attitude is going to carry you a long way to success. This is your life and your call. Do not depend on others to make it for you.
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