Resources for Insurance Professionals

Because of our extensive and exclusive experience in upper limb prosthetics, we employ a unique approach to the development of an appropriate prosthetic solution for each patient, including an expedited fitting process. Our in-house therapists provide individualized training for each patient, making sure that they feel comfortable and confident using their prosthesis. Throughout rehabilitation, we stay in touch with the nurse case manager and adjuster to keep them updated on patient progress.

Beginning with the initial evaluation, our care model integrates the involvement of a therapist during the fitting process and beyond. This results in the best outcomes for your clients in terms of their functional ability and prosthesis wear time. Our commitment to patients extends for the life of the prosthesis, allowing therapists to be involved over time. We check in at regular intervals, assisting patients with proper body mechanics and prosthetic usage as they engage in a wider variety of activities.

We treat only upper limb patients and our extensive experience in this area assures that your client will be fit with the most appropriate device for their unique presentation and needs. Our full service approach insures that each patient is evaluated and treated by an upper limb prosthetic specialist and an in-house therapist during all phases of care, including final delivery and follow-up care.

We provide individualized occupational therapy training to ensure that your client is confident about using their prosthesis in life and on the job. Integrated therapy is one of the reasons why surveys show that many of our patients wear their prosthesis at least eight hours a day.

Upper limb prosthetic options and treatments have changed dramatically in the past 10 years, but the Centers for Medicare and Medicaid (CMS) coding for upper limb prosthetics has remained stagnant. While coding is crucial in authorization and billing, new codes are only generated if the CMS receives large numbers of requests for a new code. The patient population with upper limb loss or deficiency is simply too small to generate such requests in sufficient numbers. To manage this situation, while at the same time making the most appropriate recommendation for our patients, we use a combination of listed and unlisted codes.

Nurse case managers are always invited to attend their patient’s evaluation with our upper limb team. Throughout the fitting and delivery process, we keep the carrier and nurse case manager informed of the patient’s progress, often including video progress reports. If multiple devices are recommended for a patient, we team up with the carrier and nurse case manager to develop a longer-term plan for phased care. We may start with one basic device, while working towards an optimal prosthetic solution in the future to meet all of the patient’s functional needs over time.

One of our primary goals is for each patient to be completely comfortable with their prosthesis and know how to use it to reach their maximum rehabilitation potential. We fit each patient with the most appropriate device to accomplish their goals and provide extensive training that’s designed to meet their unique needs. Prosthetic training takes place at our centers and in a variety of social settings that will help your clients adjust to using their device in real life.

We have extensive experience conducting comprehensive evaluations of upper limb amputees. Our initial assessments involve a full examination of the patient’s physical presentation, while also considering their vocational, family, social and lifestyle needs. This holistic approach offers the best opportunity to provide each patient with the most appropriate prosthetic solution for their unique circumstances.

Absolutely! We work with a wide variety of payer sources and are always willing to negotiate single case agreements.