Guide to Funding & Insurance – GT Accessible Prosthetics Initiative

Navigating the financial aspects of obtaining a prosthesis can be complex. This guide outlines various funding sources, insurance considerations, and strategies to manage costs effectively.

Insurance Coverage

Review Your Policy:

Examine your health insurance plan to understand the extent of prosthetic coverage, including any limitations or requirements.

Prior Authorization:

Some insurers require prior approval before covering prosthetic devices; ensure you complete necessary paperwork in advance.

Appeals Process:

If coverage is denied, familiarize yourself with the appeals process to contest the decision.

Crowdfunding and Community Support:

Online Platforms

Utilize platforms like GoFundMe to raise funds for prosthetic devices.

Local Communities

Engage with local organizations or support groups.

Local Charities

Many regional organizations provide supplemental funding

Financial Assistant Programs

Nonprofit Organizations

A couple of notable

Nonprofits

Limbs for Life Foundation: Provides prostheses to individuals unable to afford them.
Challenged Athletes Foundation: Supports funding for sports prostheses.
Amputee Coalition: Offers financial resources and educational materials.

Government Programs

Which government resources can be utilized for prosthetics?

Doctor in a healthcare setting consulting patients, promoting health and wellness.

Medicare:

Part A or Part B may cover prosthetic devices depending on if surgery takes place in inpatient or outpatient facilities.

A stethoscope and pen resting on a medical report in a healthcare setting.

Medicaid:

Coverage varies by state; check Georgia’s specific provisions for prosthetic services.

What is covered?
- Prosthesis limbs
- Fitting and therapy sessions
- Future device maintenance
What is not covered?
- Size and type of prostheses may be limited based on medical needs
How to apply for coverage?
- Contact your local Medicaid agency for details about coverage
- You can also apply for Medicaid in-person, online, or by mail
Who may be eligible for Medicaid?
If you are considered low income and you match one of the following descriptions, you may be eligible for Medicaid:
- Children or teenagers
- Anyone 65 years or older
- If you are considered legally blind
- If you have a disability
- If you need a nursing home for care
- If you think you are pregnant

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Veterans Affairs (VA) and Sensory Aids Service (PSAS):

Comprehensive prosthetic devices and sensory aids to eligible veterans.

Eligibility:
- Must be enrolled in VA healthcare
- You must have a medical need for a prosthetic service or device
- Other eligibility criteria may apply for certain program
Services:
- The VA covers full cost of prosthetics, including repairs and maintenance
- Prosthesis can be evaluated, fabricated, and fitted at the VA laboratory of by a VA-approved prosthetist
How to get started:
- Contact your VA health care team or primary care provider
- If you are a women, contact a Women Program Manager (WVPM) at your nearest VA medical center to discuss eligibility and care options
  - If you have any question contact the Women Veterans Call Center (WVCC) at 855-829-6636

Insurance Tips

Understand Your Policy: Familiarize yourself with coverage limits, network providers, and pre-approval processes.

Appeals Process: If coverage is denied, know the steps for appealing the decision. Advocacy groups can assist.