A myoelectric prosthetic is a prosthetic that you control with your own muscles. Sensors in the prosthetic socket receive electrical signals when you use certain muscles in your limb. The sensors send information to a controller, which moves your joints. The movements’ speed and strength can be controlled by varying the intensity of your muscles.
A myoelectric arm provides a lot of advantages over a traditional prosethetic arm that is powered by the amputee’s body. It usually is much more comfortable to wear. It gives users more functionality and a larger range of motion. It also looks more natural than a traditional prosthetic. Myolectric arms do require more care than a traditional prosethetic arm, and amputees must be prepared for that extra care. They also can’t tolerate harsh environments, such as extreme weather.
However, myoelectric arms weigh more than traditional prosthetics. They also cost more. Therefore, amputees normally must justify the extra expense to the insurance company. Patients who wish to use a myoelectric arm may point out that myoelectric arms allow amputees to control raising and lowering movements more easily. They also do not need control cables, which can be uncomfortable and may eventually cause damage to the other arm.
It’s not unusual for an insurance company to deny coverage for a myoelectric arm. But these denials are rarely justified. The insurance company will argue that it’s not medically necessary. The insurance company may require certain standards to be met for the patient to be eligible for a myoelectric arm, such as for those with certain types of injuries, or someone who can’t perform the functions of daily living with a standard device.
But the bottom line is that insurance companies want to maximize their profits by denying benefits whenever they can. Prosthetics are expensive and insurance companies generally don’t like paying for them. Therefore, they may look for reasons to deny coverage. If this denial is in bad faith, the insurance company can be forced not only to pay for the cost of the prosthetic, but also for damages related to the denial.
If your insurance company has denied coverage for your myoelectric arm, and you believe they are acting in bad faith, you have legal rights.
Call me, Conal Doyle, Amputation Attorney and amputee, at 310-385-0567. I will evaluate your case and determine the best course of action. Call today to learn more.