Getting Your Prosthetic Device – Referrals and Prescriptions
by Arm Dynamics, on Mar 17, 2020 1:23:35 PM
The journey from the day you decide you would like to have a prosthetic device to donning the device can be, of course, rewarding. It can also be confusing. That’s why we have created a series of articles about the ins-and-outs of how you can work with your care team to get what you need. Be sure to read through the start of our series “Getting Your Prosthetic Device – First Steps” if you haven’t already.
In that article, we touched on how one of the first steps is to speak with your physician. Your physician will be the one who can write a referral for you, if necessary, and they will be the one to sign the prescription for the device and a Statement of Medical Necessity (SMN), both of which your insurance company will require.
Many people today are used to needing referrals to be able to see any medical professional beyond their primary care physician. Most insurance companies will not allow you to self-diagnose, say, a knee problem and simply book an appointment with an orthopedic specialist. But! Referrals are not usually necessary when it comes to wanting to start the process of an authorization for a prosthetic device. There are times, though, especially for those with HMO health plans with no out-of-network benefits, that an insurance company will require a referral from an in-network physician before beginning the authorization process for a prosthesis.
How will you know if your insurance company will require a referral? We’ll be able to tell you as we go through the process with you. One of your first steps when looking to get an upper extremity prosthetic device should be to schedule a consultation with us, which you can do by filling out the contact form at the bottom of this page. During the process, we will ask for your insurance provider and speak with them to determine what documentation you will need as you go along.
Prescriptions and Statements of Medical Necessity
Another question you might have is whether or not you need to meet with your doctor before you meet with a prosthetist (ideally an upper limb specialist). The answer is no. You can get all the information you have been wondering about before going to your doctor and asking them to help you with next steps. But you will need a prescription before you can get a prosthetic device.
During your evaluation with Arm Dynamics, both a prosthetist and a therapist, each of whom are upper limb specialists, will go over what your goals are with a prosthetic device, what options are available and which is most appropriate for you. Once you have all come to a decision about what would be best for you, our clinical team will write out the exact components that you will need to thrive and why they are medically necessary for you. If we believe that a silicone socket would be best for you because you have a bony prominence that would be irritated by a plastic socket, that will be included in that document. If a myoelectric hand has been determined to be the best option for you, the exact type and brand will be included in that document. We will also include training – what we call Prosthetic Rehabilitation Coordination – in that document. We include that because there’s no point in fitting you with a prosthetic device if we don’t teach you how best to use it.
To recap, you don’t need a referral or prescription to have a consultation with us – and you don’t need to worry about how you will get either of those things, because helping you get those documents is part of what we do here at Arm Dynamics.
In other blog articles, we discuss how to get care with an out-of-network prosthetic care team and how to advocate for yourself when dealing with your insurance provider. In addition, you can read about How Our Justification, Authorization and Billing Team Helps Advocate on Your Behalf.
In the comments below, please tell about what part of the process you’re looking forward to learning more about! And be sure to contact us using the form at the bottom of the page with any questions you may have or to schedule a consultation.