Why insurance companies are denying coverage for prosthetic limbs
PBS News Hour - Segments
PBS NewsHour
4.1 • 1K Ratings
🗓️ 13 April 2025
⏱️ 6 minutes
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| 0:00.0 | More than 2 million Americans are living with limb loss. |
| 0:05.0 | A government accountability office report says that number is expected to almost double by 2050. |
| 0:11.0 | Yet recent reporting by KFF Health News finds that many who've lost limbs are hitting roadblocks |
| 0:18.0 | when they try to get insurance to cover the cost of prosthetic limbs. |
| 0:22.6 | Some companies even question whether these life-changing devices are medically necessary. |
| 0:27.6 | Ali Rogan spoke with Michelle Andrews, a contributing writer for KFF Health News. |
| 0:33.6 | Michelle, thank you so much for joining us. Why are these denials happening? And what do we know about |
| 0:38.6 | the scale of the problem? Well, I can't actually speak for the insurers, but I can say that when |
| 0:44.5 | I've asked them about denials, they've said, well, we do, in fact, cover these prosthetics when |
| 0:50.2 | they're medically necessary to replace a body part or use every day. But when you talk to, |
| 0:56.9 | you know, advocates, you find out that that's not actually the case. There are a couple million |
| 1:01.9 | people who need prosthetics. And so, you know, given that these are fairly expensive items, |
| 1:08.0 | I think it's one of those things that, you know, maybe on the chopping block when |
| 1:11.7 | they're looking at ways to save money. And, you know, these are for-profit entities. That's a very |
| 1:17.1 | good point. Are we seeing this happen more with private insurance, Medicare or Medicaid, or is there |
| 1:22.5 | really no distinction? There's a big difference. Public insurance, Medicare, the VA, Medicaid, to some degree, they're pretty good about covering prosthetics. |
| 1:36.1 | But in private insurance, you do see some, you know, good coverage, but it's all over the map, from what I'm told. |
| 1:42.2 | And that can mean that it really isn't very good at all. |
| 1:45.5 | We spoke to a number of people who either have had their request for coverage denied. |
| 1:50.8 | Some are still fighting. |
| 1:51.9 | Some have received their prosthetics, but only after an appeals process. |
| 1:55.5 | I want to play some of their stories. |
... |
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