Cedar City Woman Fights To Have Prosthetic Foot Covered By Insurance
Apr 30, 2019, 10:37 PM | Updated: May 1, 2019, 5:27 pm
CEDAR CITY, Utah — Heidi Decker’s leg was amputated due to complications from diabetes. Her solution: a prosthetic leg and foot.
“Seven years ago I broke my foot and it never healed correctly,” Decker said. “I got a prosthetic but it left me in pain. I was walking with what I called a brick foot because, there is no flexion.”
Utah Prosthetics and Orthotics offered a solution by creating Decker a custom foot.
“I thought okay I want to get her in a foot that will actually allow her to do everything that she really wants to do,” said Matt Bracken, Certified Prosthetist Orthotist and owner of Utah Prosthetics and Orthotics.
Bracken said his company received pre-approval from Decker’s insurance company, Aetna, to make her the custom foot but when the insurance payment came it was way less than what he was expecting.
"They said they’ve paid all they are going to and I’m stuck with the rest.”
A Cedar City woman says a custom prosthetic foot she thought her insurance would help cover is now too expensive to keep. At 10:00, her solution and the response from her insurance company @KSL5TV pic.twitter.com/A9X81Djk4D
— Ashley Moser (@AshleyMoser) May 1, 2019
“It ended up not paying for the prosthetic foot, which was my cost over $4,000,” he said.
Decker said she signed up for an 80/20 insurance plan which is why she was shocked when the payment came. She called her insurance company to see what she could do to resolve the issue.
“They said they’ve paid all they are going to and I’m stuck with the rest,” Decker said.
Utah Prosthetics and Orthotics decided to let her keep it and to take the costs on themselves until they get this resolved with her insurance.
KSL reached out to Aetna. The company said they could not discuss Decker’s case due to privacy laws.
In an email, the company offered this explanation:
Ms. Decker has a plan which has a $5,500 deductible. All members have to meet their deductibles before Aetna covers the claim. For Ms. Decker’s specific plan, prosthetics are covered at 75% by Aetna after the deductible has been met. After Ms. Decker met her $5,500 deductible and her 25% coinsurance responsibility on these claims, Aetna paid out $1,834 for her prosthetic device in accordance with the member’s plan.
Once the Executive Response Team has time to research the issue and make a determination of what happened, they may reach out to the member directly.