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Heather Mills - Amputee Forum
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nettie

An Appeal to Kaiser

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Hello Everyone~

It's been awhile since I have been on the forum, but it's great to be back! I am currently in the process of writing an appeal to my insurance company to cover repairs to my prosthetic skin covering. My previous insurance did cover it so I am hoping that I can make a change in the way my new insurance views prosthetic skin covers. It a battle, I know, but I am going to try!

I was hoping some of you would have stories for me or reasons why a skin covering is a necessity for you or why you feel you need to have one. I don't believe that a sking covering should be labeled as "cosmetic" any longer. The more that we make our needs to insurance companies heard loud and clear the more of a chance we will have to get the coverage we need without having to battle for it. If you have something to contribute, please let me know!! Thank you!

Janette

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I've never had an actual "skin" covering, and Kaiser does cover my normal "foam and stockings" cosmesis, Janette, but I thought about trying skin in my "early amp days." My prosthetist did a lot of work for Kaiser and he did give me some suggestions on how to approach them. Primarily, he said to emphasize the "protective" and "practical" aspects of the skin covering. Appearance and "emotional well-being" aspects should be a secondary, minor issue in the request...the idea is that you not try to make it seem "cosmetic."

Nowadays I'm actually looking for ways to make my leg more of a "personal statement," and my curiosity about "skin" has faded...but if you can get coverage from Kaiser, I'm sure there would be many amps who would be thrilled and grateful for your efforts.

Good luck! :smile:

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Hi Cheryl~

Thanks for the advice! In the letter of appeal I have started I am focusing on that exact approach. Hopefully they will understand how important it is to even have the option of skin available. Thanks again!

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Hello Everyone~

It's been awhile since I have been on the forum, but it's great to be back! I am currently in the process of writing an appeal to my insurance company to cover repairs to my prosthetic skin covering. My previous insurance did cover it so I am hoping that I can make a change in the way my new insurance views prosthetic skin covers. It a battle, I know, but I am going to try!

I was hoping some of you would have stories for me or reasons why a skin covering is a necessity for you or why you feel you need to have one. I don't believe that a sking covering should be labeled as "cosmetic" any longer. The more that we make our needs to insurance companies heard loud and clear the more of a chance we will have to get the coverage we need without having to battle for it. If you have something to contribute, please let me know!! Thank you!

Janette

I'm over here in the UK,so insurance not an issue, but like Cheryl have never had skin covers either, I too have standard foam and stockings, though notice a lot of new amputees either here are given a silicone cosmesis almost immediately. I am not overly bothered, but wouldn't mind it on my main prostheses as there are some occasions where a girl likes to look her best. A disadvantage of the foam and stockings is that it gets quite dirty and the feet will often mark through the stockings, the stocking they fit is usually thin and ladders, though can be easily replaced with sticky tape, though if the foam has to be taken off for repeated repairs or adjustments, never tends to look as good when first fitted.

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Hello Everyone~

It's been awhile since I have been on the forum, but it's great to be back! I am currently in the process of writing an appeal to my insurance company to cover repairs to my prosthetic skin covering. My previous insurance did cover it so I am hoping that I can make a change in the way my new insurance views prosthetic skin covers. It a battle, I know, but I am going to try!

I was hoping some of you would have stories for me or reasons why a skin covering is a necessity for you or why you feel you need to have one. I don't believe that a sking covering should be labeled as "cosmetic" any longer. The more that we make our needs to insurance companies heard loud and clear the more of a chance we will have to get the coverage we need without having to battle for it. If you have something to contribute, please let me know!! Thank you!

Janette

I'm over here in the UK,so insurance not an issue, but like Cheryl have never had skin covers either, I too have standard foam and stockings, though notice a lot of new amputees either here are given a silicone cosmesis almost immediately. I am not overly bothered, but wouldn't mind it on my main prostheses as there are some occasions where a girl likes to look her best. A disadvantage of the foam and stockings is that it gets quite dirty and the feet will often mark through the stockings, the stocking they fit is usually thin and ladders, though can be easily replaced with sticky tape, though if the foam has to be taken off for repeated repairs or adjustments, never tends to look as good when first fitted.

I agree with you, sometimes it is nice for special occasions to have a cover. But even in everyday life it prevents so much dirt and staining! Wish me luck!

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In case anyone was interested...my Doctors and the heads of rehabilitation are supporting my appeal and I just had a conference call with a panel of 12 peopel regarding the need for a skin covering for some amputees. Keep you posted!

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Thanks for the update...it sounds like they're at least taking you seriously. I have given up my cosmesis at this point, and it's been a very "empowering" feeling to have made my own decision about what my leg should look like. I would think that would be true for someone who's wanting a "skin" cover as well. So, beyond the practical issues of "skin" versus "foam and stockings," I hope you get to experience having a leg made to YOUR specifications! Good luck!

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Thanks for the update...it sounds like they're at least taking you seriously. I have given up my cosmesis at this point, and it's been a very "empowering" feeling to have made my own decision about what my leg should look like. I would think that would be true for someone who's wanting a "skin" cover as well. So, beyond the practical issues of "skin" versus "foam and stockings," I hope you get to experience having a leg made to YOUR specifications! Good luck!

Thanks Ann......and.....I WON!!!! They approved the repairs to my skin covering!!! WHOO HOOO!!!! Hopefully this will empower other amputees who prefer the protection of an outer skin fight the system!

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