Prosthetics need effective claims management

Prosthetics in amputations claims require advanced assessment capabilities

Workers Comp

By Allie Sanchez

Home Care Orthotics and Prosthetics director Jan Saunders said in a recent report that the use of increasingly sophisticated technology in prosthetics or artificial limbs is driving up the cost of compensation in amputation.

Citing a 2016 Travellers’ Injury Impact report, he said that amputations are costly because they also require a myriad of expenses including surgery, hospitalization, medication, home healthcare and the services of various healthcare professionals.

In addition, artificial limbs, which have become more advanced in the past 10 years, could ring up an average five-year cost of up to $450,000, Saunders said.

He further said that prosthetic costs are usually centered on issues with care, especially when the employee does not immediately receive proper medical care after the injury and amputation.

Also, delays in authorization and treatment result in higher accumulated costs, as cases where employees are not evaluated and fitted with prosthetics immediately after surgery keeps them sedentary longer. Thus, they are unable to achieve maximum recovery outcomes and resume productive activities after the accident.

Another major issue, Saunders pointed out, is the lack of familiarity of claims managers with prosthetics billing codes, which may lead to confusing or inflated quotes. He said prosthetics themselves are expensive, usually costing from $15,000 to $70,000 for a typical leg, depending on its features.

Thus, he recommended that assessment should take into consideration the employee’s lifestyle, psychosocial state, lifestyle, workplace demands, and functional capacity.  
 

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