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Financial Assistance Resource: First Step-A Guide for Adapting to Limb Loss
A Publication of the National Limb Loss Information Center

Some of the questions most frequently asked by amputees are related to the purchase of prosthetic devices, whether it be wheelchairs, ramps or other adaptive equipment. The cost for these can be exorbitant and most amputees will require some kind of financial assistance to obtain the equipment needed to maintain their independence.

Some funding resources require a 'justification' statement before funds are given. Private insurances, etc. are such cases.

Medicare: In the U.S., Medicare is the largest financial resource for prosthetic care. In addition to prostheses, Medicare commonly covers wheelchairs, walkers, and crutches. Ramps, adaptive driving devices and other non-medical devices are NOT covered.

Social Security Disability: For those under age 65, the first major obstacle to obtaining Medicare coverage for assitive devices may be getting approval for SSD benefits.

 Approximately 70-75% of SSD applicants are denied initially. Persistence, detailed documention of your medical history, and the help of an attorney are often the keys to getting approval.

If your claim is denied: If your Medicare claim is denied, it is important to understand why, and to find out what options you have left. Reasons for denial of claims for DME (Durable Medical Equipment) and prosthetic devices usually fall into five categories.

1. Lack of medical necessity.
2. Non-covered services. Medicare has excluded these items from its list of covered services.
3. Incomplete information.
4. Duplicate submission. Claims denied for this reason should be investigated immediately.
5. Not Separately payable. These claims were denied because the service was considered to be included in another code.

Medicaid: Medicaid is a jointly funded cooperative venture between the federal and state governments to assist states in the provision of adequate medical care to eligible, needy people. Within broad national guidelines that the federal government provides, each of the states:
  1. Establishes its own eligibility standards.
  2. Determines the type, amount, duration, and scope of services.
  3. Sets the rate of payment for services
  4. Administers its own program
Medicaid eligibility and covered service vary considerably from state to state as well as within each state. Unfortunately, coverage for prosthetic care is not mandated; therefore, it ranges from reasonably good to nonexistent. Check with your local office for eligibility.

Veterans Administration: For a broad view of what the VHA provides, visit their website at www.va.gov/About_VA/Orgs/VHA/index.html or call the VA Health Benefits Service Center toll-free at 1-877-222-VETS.

Vocational Rehabilitation: Most states have vocational rehabilitation programs to  help people with limb loss obtain and keep employment. These programs vary widely from state to state as to the eligibility requirements and services provided. Some may fund prosthetic care and other assistive devices if they are deemed necessary for employment or job performance. Assistive devices such as wheelchairs. lifts and adaptive driving equipment are often furnished to enable a person to get to the job site. Visit www.pueblo.gsa.gov/crh/vocational.htm for contact information and links to your state vocational rehabilitation agency's Web site.

State Technology Assistance Programs: These programs support statewide, comphrensive, technology-related assistance for individuals of all ages with disabilities. State projects typically provide assistance in choosing and acquiring off-the-shelf, modified, or customized items and equipment used to increase, maintain or improve functional capabilities of individuals with disabilities. The telephone number for your state's program may be found in the 'blue' pages of your local directory.

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