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What Is A K Level And How Does It Affect What My Insurance Will Pay For?

K level is important. It is a rating system that Medicare uses to measure an amputee’s rehabilitation potential. The K level system runs from 0 through 4. It indicates an amputee’s potential to use a prosthetic device.

Medicare does not want to pay for a person’s prosthetic, which is extremely expensive, if they won’t use it. Many insurers also rely on the K level to determine whether they will or won’t pay for a prosthetic.

There are five K levels. Level zero amputees do not have the ability to move or transfer with or without assistance, and do not need prosthetics. Level one amputees have the ability to use a prosthetic for transfers or for moving on flat surfaces. This may be a person who only walks in his or her home.

Level two amputees can do some movement on slight steps or uneven surfaces such as stairs. Level three amputees can move in most environments and may be active, which could require more complex prosthetics. Level four amputees have the potential for more complex ambulation, and may be children, active adults or athletes.

Your doctor determines your K level, which is critical since that determines what Medicare or your insurance company will pay for. If you believe that your K level is too low, which means that you will not get the prosthetics you want or need, talk to the doctor. You should make sure that he or she has all relevant information and documentation. You will also want to visit him or her regularly so that the documentation stays up to date.

If your insurance company is denying your claim for a prosthetic, rehab, or any amputation-related service or device, they may be acting in bad faith. Call me, Conal Doyle, Amputation Attorney at 310-385-0567. I help amputees with their claims against insurance companies.

You may not only be awarded payment for the device or service, you could also be entitled to compensation from the insurance company for their wrongful actions. Call today to learn more.

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