Insurance Company Denied Twelve Year Old’s Prosthetic Arm

posted on Nov 18 by Stacy in the Disability News category

Michigan is one of 33 states that allow insurance companies to set annual and lifetime caps on prosthetic devices. So when 12 year old Benjamin French, who was born with his right arm missing below the elbow, once again grew out of his prosthesis, his insurance company denied coverage because he had already spent his lifetime maximum benefit. Benjamin’s new replacement would be his seventh in 12 years, and his new replacement will cost almost $30,000. His doctor says that he will soon grow out of that one too. If Benjamin lived in Colorado or Maryland he would be able to receive a new arm with the same insurance company because the law does not allow a cap on prosthetics.

The Amputee Coalition of America has reported on this issue in the past, with amputees reporting a wide variation in insurance coverage, with some companies paying no more than $1,000 per year for prosthetics, and others only allowing one prosthetic per lifetime!

“It seems really unfair,” said Benjamin’s mother, Kristen French. “The insurance company can do this in one state, but not in another? It’s ridiculous.”

Have you ever been denied care that you might be able to receive in another state? How did you fight it?

Source.