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impala

Very disappointed and don't know what to do

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I am new to this forum. I am a LBK due to a motorcycle accident ten years ago. My amputation was done in Calif at a hospital about three hours away, and my leg man was there too. He was awesome and gave me the best care ever. He would take a casting and have in ready in two weeks with very little fine tuning, if any. It was comfortable and if someone didn't know me they never knew I was wearing a prosthesis. My insurance is no longer contracted with my leg man and he has taken another job in the same field but not seeing patients. I decided I needed to find someone else nearby. Last year I had a socket made here. What a fiasco this has been! This leg man proceeded to do his own thing saying the way I had had a socket made was 'old school.' I told him the new socket he made was uncomfortable and was making my knee swell, he said it wasn't fitting because I had gained weight...not true. I could not wear the socket at all. He would not listen to me and I felt like I was talking to the wall I said screw it and never went back to him. The socket he made sits in my closet. In January of this year I decided to try someone else with the recommendation of a doctor friend of mine. This leg man has been working on a new socket for six months and am still without a new one. I have never heard of this, but he has sent it off to be computer sized three times now. Two weeks ago I brought the test socket home to try out . It is still uncomfortable and hits me wrong at the knee and needs more work. I have been putting off going back because I am frustrated and don't know what to do from here. At my first visit they wanted me to put money down, I gave them $500. I knew I had my deductible and my share of cost. They have billed my insurance and they have paid their part. Now they want me to start making payments on my share approx $2600. I don't think I need to pay for something I don't have. I have lost all confidence in this guy and am not sure if this socket will ever be right. Does anyone have any suggestions on what my options might be. Thanks for listening.

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Wow...that's quite a story! I'm not sure what to advise re: the money issue. I've never had a co-pay or deductible on my everyday walking prosthesis...and I know I'm very fortunate on that front! The one time I did pay for a prosthesis, it was for my water leg, which my insurance did not cover at all. In that case, there was no payment requested until I took delivery on the "final" leg, at which point I needed to pay in full. If anyone else out there has been through a situation closer to yours, I hope they'll chime in here.

As for finding yourself in need of a new prosthetist, well, that can be a struggle. It sounds like you lucked into a really great relationship with a truly competent prosthetist at first. It's too bad that coverage, distance, and career moves put an end to that relationship. Since you've been at this amputee business for a good long while, I'm sure you understand just how important your leg guy can be in your life. You're right that it would be good to find someone closer to you...but it sounds like you've had some real problems there. I've never had one of my sockets sent off for computer fitting, so I guess I'm "hopelessly old-school"....but, like your original leg guy, my "old-school" leg men have fit me just beautifully over the years. The one time I did have problems with fitting a socket, it was because I was just depressed and out-of-sorts and didn't contribute anything in the way of communication to the fitting process. Once my "old-school" leg guy hauled me up short and asked "What the heck is up with you, anyway? It's not like you to not have anything to say," we got back down to business and I was fine...and so was the socket.

Can you remember what it was like with your very first socket? After having a long time without needing to worry about your legs...after having someone who knew you so well and could automatically adjust your sockets to what he knew would work for you, starting over with someone new would be frustrating all on its own, even if there were no other problems. When you do decide on a new leg guy, try to keep that "very first socket" experience in mind...it is, after all, the very first socket that person is building for you.

Now that I've rambled on for a while, my personal opinion is that you have a valid point in not wanting to pay for a leg that you've not yet received. I'm actually surprised that your insurance has paid for a leg you've not yet received...I do have some experience with insurance billing (from a time long, long ago), and at that point in time, insurance companies did not pre-pay! Six months seems like an extremely long wait for a socket, even if you have been complaining about the fit of the test socket. I think that, if it were me, I'd at least report the lack of progress to the insurance company and see if you would be able to make a fresh start with someone new.........

Wish I had something more specific for you, but I do wish you the best in getting it all sorted out properly. Anyone else with ideas??

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I am really new to all of this myself. My advise may be wrong but I do not believe the new guy would get any more money from me until I could try the product. The time you are spending without the leg is not right. I hope things improve for you soon. Keep the faith.

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Hi Impala

Can't advise you on the money issues ... but can emphasise with your situation. I live in a different part of the world to you with a different system but I too ended up in a similar situation when after many years of walking without too many problems I was assigned to somewhere with new ideas and ended up with problems.

My advice to you really though regards the prosthetics, is trust your instincts. I should have done this initially when I was being promised all sorts of benefits of a new type of prosthesis, all through the fitting processes there were niggling doubts in my mind over what I was being told, but because previously I'd had no cause to question what I was being prescribed, I went along with it and I should have addressed those niggling doubts. I've learned it's quite common to be told the reason why the prosthesis doesn't fit or work is because you've put on or lost weight, which sometimes may be the reason, but not always the case especially with someone who has been an ampute for many years.

I ended up going to quite a few different places, different people etc. etc., and had varying experiences along the way and somewhere along the line have learned to trust my instincts and not let anyone give me anything I am not 99.9% sure of.

Now and again I do come across prosthetists who tell me if I tried this, or used this product/component or whatever, I might be able to do this that or the other and these are the ones I am very wary of .... I am much more confident with a prosthetist who looks at what works for me and starts off from that point. I know this probably sounds very unadventurous to some people, however, having had the experiences I have, and with not the most accommodating of stumps to be fitted, I am both grateful for and protective of the mobility I have, so am now very wary of letting anything jepodize that.

Good luck with getting the financial side of this sorted and getting a comfortable prosthesis made, you might have to look further afield for someone who can accommodate you better, but don't give up on it, there will be someone out there who can help you.

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No money should change hands until a final leg is produced. Did you sign off on the leg? I would call your insurance company to make sure they've already paid. If they have, they need to try to get that back. You should also try to get your money back. Then take the advice of another amputee not a doctor about the next legman you see. Find a support group in your area. Travel some distance if needed. Are you still in California? There are many great facilities there.

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Most insurance companies will not pay for a prosthesis until the patient has signed a delivery statement. This means that the final leg has been delivered to the patient and that he/she is pleased with the result. I never sign anything releasing them to bill insurance until the final leg is delivered. My leg shop is/has been very good at working with me. They are always very professional in dealing with this. I've never had them bill me for any repairs or adjustments made after the delivery.

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I believe u have the correct info now...do not pay anymore.....leg does not fit....in my case they tried the computer fitting & that was a total mess as the guy running it was an idiot. Didn't know how to use it., and just kept stringing me along. In fact after a year it still didn't fit. Had to contact the main company to get another one made without paying for it. Bad thing is, the manager of the office where it was made wasn't much better. :sad: You can really get taken by some of these places. Do what Neal has told you.

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In my experience with insurance, Neal's right....... Don't sign any delivery ticket until you like the fit and are sure it's going to work...And one other thing that you might want to consider.... If these guys are billing for your sockets, they aren't right, and insurance has paid their part...You might also get the insurance company involved. I done that once about some work with a dentist that was paid for and the insurance company got their money back, and blacklisted him in their network. This guy done lots of business with the same insurance company,(which is a self funded insurance with the company my hubby retired from) and he lost a lot of business when it happened... Sent me a don't come back letter.. but hey, I never intended to come back after that anyway, so his little letter didn't hurt my feelings..

Just because they make our limbs, does not mean we have to put up with shoddy work...Keep on them.....

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One other thing to think about...... You can "interview" a new "prospective" prosthetist as well.. Just because you go and talk with them, doesn't mean you have to hire them.. Call up someone else, and ask to come and see them to see if you and they will be a "good fit", for lack of a better way to put it. I research doctor's before I go see one. I most certainly would do it if I ever have to get a new leg guy.......

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