Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity

This is a MedPage Today story. When Michael Adams was researching health insurance options in 2023, he had one very specific requirement: coverage for prosthetic limbs. Adams, 51, lost his right leg to cancer 40 years ago, and he has worn out more legs than he can count. He picked a gold plan on the Colorado health insurance marketplace that covered prosthetics, including microprocessor-controlled knees like the one he has used for many years. That function adds stability and helps prevent falls. But when his leg needed replacing last January after about 5 years of everyday use, his new marketplace health plan wouldn't authorize it. The roughly $50,000 leg with the electronically controlled knee wasn't medically necessary, the insurer said, even though Colorado law leaves that determination up to the patient's doctor, and his has prescribed a version of that leg for many years, starting when he had employer-sponsored coverage. "The electronic prosthetic knee is life-changing,"...

Topics

The end of insurance: Climate change is destroying homeowners and insurers

Traditional insurance models aren’t able to handle escalating natural disaster risks.
MarketWatch - 5h
Experts question medical evidence that led to murder conviction of British nurse

A panel of expects is disputing the medical evidence used to convict British nurse Lucy Letby of murdering seven newborns and trying to kill seven others
ABC News - 15h
Experts question medical evidence that led to murder conviction of British nurse Lucy Letby

Yahoo News - 16h
Serbian State Media Shift Tune in Coverage of Huge Protests, Testing Leader

State TV had previously largely ignored the demonstrations against President Aleksandar Vucic, but now it is putting a spotlight on the rallies.
The New York Times - 1d
Trump to be interviewed during Fox Super Bowl pregame coverage

President Trump will sit for a wide-ranging interview with Fox News anchor Bret Baier set to air before the Super Bowl on Sunday. Sunday's conversation "will focus on the changes the Trump ...
The Hill - 1d
An inside look at "Medical Aid in Dying"

In the U.S., ten states and the District of Columbia allow terminally ill people the right to decide if they want to take medicine to end their life, a process known as "Medical Aid in Dying," or ...
CBS News - 4d
NBC4 Washington coverage of passenger plane and Army helicopter collision

Watch live coverage from NBC4 Washington after American Eagle Flight 5342 carrying 60 passengers and four crew members collided midair with an Army helicopter near Reagan Washington National Airport.
NBC News - 5d
NBC Washington coverage of Potomac crash

NBC Washington coverage of Potomac crash
NBC News - 5d
Why the home insurance model is broken

Wildfires ripped through Southern California this month leaving more than 16,000 structures destroyed and insurers facing $40 billion in payouts.
CNBC - Jan. 27
New York City Mayor Adams to have 'routine' medical tests, limit schedule

"Over the last few days, Mayor Adams hasn't been feeling his best," Fabien Levy, deputy mayor for communications, said on social media late Sunday.
ABC News - Jan. 27
Eric Adams to Limit Public Schedule to Undergo Routine Medical Tests

Mayor Eric Adams of New York City will undergo tests and meet with doctors this week because he is not “feeling his best,” his office said. No other details were released.
The New York Times - Jan. 27
2025 Farmers Insurance Open TV schedule, coverage, channel, live stream, where to watch Torrey Pines event

This week's PGA Tour event in San Diego runs from Wednesday through Saturday
CBS Sports - Jan. 25
The GOP debt limit jam

Welcome to The Hill's Business & Economy newsletter {beacon} Business & Economy Business & Economy The Big Story GOP faces tough decision on debt limit Some House Republicans are getting anxious ...
The Hill - Jan. 24
Beijing tells insurers to buy more Chinese stocks

Equities rally as authorities set explicit investment targets for mutual funds and state-owned insurance companies
Financial Times - Jan. 23
Will Zalatoris a late withdrawal from Farmers Insurance Open

The field for the Farmers Insurance Open took another hit Wednesday when Will Zalatoris withdrew.
Yahoo Sports - Jan. 22
What's covered under home insurance and what's not

Home insurance can help protect your home from disaster damage, but policy details may vary.
CBS News - Jan. 22
Flow Specialty launches the 1st AI insurance broker

Flow Specialty, a specialty commercial brokerage, is announcing the industry’s first AI insurance broker. The brokerage’s platformless AI model has passed RPLU certification exams for the Cyber, ...
VentureBeat - Jan. 22
How to insure physical gold

Insuring your gold can help protect this critical investment. Here's how to do it.
CBS News - Jan. 22
Insurers Were Right About California’s Wildfires

Regulators in California made it difficult for insurers to raise rates despite increasing risks. So the insurers stopped writing policies, which is logical. But they’ll get blamed and shamed anyway.
Inc. - Jan. 21
Comprehensive vs. collision auto insurance: What's the difference?

These coverages can protect your vehicle, but they're not always required — or necessary. Here's what to consider.
CBS News - Jan. 21
Live inauguration 2025 coverage as Trump returns to power

Donald Trump is now the 47th president of the United States. Follow live coverage and watch a live stream of the inauguration events here.
CBS News - Jan. 20
L.A. wildfire coverage shows why local TV news matters in a crisis

The city's reporters and anchors with roots in the community go beyond the call of duty in a time of devastation and loss.
Los Angeles Times - Jan. 19
Watch live coverage on Sky News

Watch live coverage on Sky News
NBC News - Jan. 19
NFL play-offs schedule, kick-off times and BBC coverage

The full schedule for the NFL play-offs as 14 teams battle it out to reach Super Bowl 59 on 9 February.
Yahoo Sports - Jan. 18
Who qualifies for long-term care insurance coverage in 2025?

Purchasing this type of coverage is a smart move for your finances, but you'll have to qualify first.
CBS News - Jan. 17
Our Insurance System Subsidizes Moves to Disaster Zones

Our policies encourage Americans to flock to areas particularly prone to climate-related disasters.
The New York Times - Jan. 16
Live coverage: Biden's farewell speech comes on heels of raucous confirmation hearings

President Biden delivered a somewhat grim primetime farewell speech on Wednesday from the Oval Office to mark the final days of his presidency. The speech is among Biden's last as president and ...
The Hill - Jan. 16
Lazio fires eagle mascot handler for posting graphic photos of prosthetic genitalia

The handler also faced criticism for speaking positively of Benito Mussolini
CBS Sports - Jan. 14
TV presenter Katie Piper reveals decision to use prosthetic eye shell

Survivor of acid attack and advocate for people with burn injuries posts update ‘after years battling with eye health’. The TV presenter Katie Piper has revealed she is trying out an “artificial ...
The Guardian - Jan. 11
California Wildfires Lay Bare an Insurance Crisis

Even before the latest blazes, California officials warned that an emergency state insurance fund was in trouble, while private insurers dropped coverage.
The New York Times - Jan. 10
‘A risk to life and limb’: residents of Germany and Netherlands rue dangers of fireworks

Authorities are reluctant to curb excesses of a new year’s tradition that is causing life-changing injuries. Seven-year-old Necati Karki had gathered with his family as part of a crowd in their ...
The Guardian - Jan. 10
WATCH: Insurance expert on how to prepare for insurance claims amid California fires

ABC News’ Linsey Davis speaks with insurance broker Karl Susman about the difficulty of insuring homes and making fire claims in California as residents begin to survey the damage left by the fire.
ABC News - Jan. 9
Live coverage: Biden honors Carter, as Trump, former presidents gather for funeral

The nation paid its respects to former President Carter on Thursday, with five presidents gathered at Washington National Cathedral for his funeral service. President-elect Trump joined by ...
The Hill - Jan. 9
Watch live coverage on NBC Los Angeles

Watch live coverage on NBC Los Angeles
NBC News - Jan. 9
Bank of England to relax rules for banks and insurers

PRA’s Sam Woods says burden can be eased without ‘race to the bottom’ on financial regulation
Financial Times - Jan. 8
KNBC coverage of L.A. wildfires, driven by powerful winds

Watch live KNBC coverage as multiple wildfires are engulfing the Los Angeles area, prompting mandatory evacuations and leaving millions of people under red flag warnings.
NBC News - Jan. 7
Live coverage: Carter honored at Capitol; Trump fields smattering of questions ahead of inauguration

Former President Carter is being honored at the Capitol, where he will lie in state until his funeral on Thursday morning at the National Cathedral. Senators, Supreme Court justices and other ...
The Hill - Jan. 7
Insurers limit coverage of prosthetic limbs, questioning medical need

Only 30% of beneficiaries who lost a limb in 2016 received a prosthesis within three years, a report found.
CBS News - Jan. 6

More from ABC News

Ohio governor orders state employees back to in-office work 5 days a week starting in March

Republican Ohio Gov. Mike DeWine has ordered state employees back to full-time in-office work
ABC News - 7h
New York attorney general tells hospitals to continue transgender care after Trump’s executive order

New York Attorney General Letitia James is telling hospitals that they would be violating state law if they stop offering gender-affirming care for people under age 19 in response to an executive ...
ABC News - 1d
New governor tests relations with North Carolina lawmakers with aid request for Helene recovery

North Carolina Gov. Josh Stein has asked state legislators to double their spending to date on Hurricane Helene recovery and approve it now
ABC News - 1d
Hospitals in eastern Congo are crowded with wounded and exhausting their supplies

Hundreds of wounded people have poured into overcrowded hospitals in Goma after Rwanda-backed rebels captured the major city in eastern Congo last week
ABC News - 1d
Africa knew Trump's 'America First' pledge meant it might be last. Then came the freeze on aid

Many Africans knew that Trump’s “America First” outlook meant their continent was likely to be last among his priorities
ABC News - 1d

More in Health

Ohio governor orders state employees back to in-office work 5 days a week starting in March

Republican Ohio Gov. Mike DeWine has ordered state employees back to full-time in-office work
ABC News - 7h
Alcohol Makes Me Anxious. Is That Normal?

We asked experts if alcohol can cause anxiety to spike and what you can do about it.
The New York Times - 18h
The U.S. Is Having Its Mildest Covid Winter Yet

But there have been plenty of other illnesses to go around.
The New York Times - 18h
New governor tests relations with North Carolina lawmakers with aid request for Helene recovery

North Carolina Gov. Josh Stein has asked state legislators to double their spending to date on Hurricane Helene recovery and approve it now
ABC News - 1d
New York attorney general tells hospitals to continue transgender care after Trump’s executive order

New York Attorney General Letitia James is telling hospitals that they would be violating state law if they stop offering gender-affirming care for people under age 19 in response to an executive ...
ABC News - 1d