Home    Clients    Staff    Contact    Locations    FAQs    Technology    Devices    In the News    Links    Payment    Warranty Q. When will I be ready for my prosthesis? A. Doctor's use the following criteria in deciding when you are ready for your artificial limb: Your incision doesn't have to be totally healed, but should be nearly healed to reduce the risk of skin breakdown when you are using your artificial limb. Swelling in the residual limb should decrease through the use of elastic bandages or shrinker sockets. For above-knee amputees, the residual limb should not be larger on the end than at the upper thigh. For below-knee amputees, the residual limb should not be larger at the end than at the knee. This will allow your limb to fit well into your socket and be able to support your weight effectively. Also, you must regain overall strength following surgery to allow you to walk safely. On average, fitting for a prosthesis will begin 3-6 weeks after surgery. Your doctor is the best judge of your ability to walk safely with a prosthesis; your doctor will ultimately decide when you are ready for your artificial limb. Q. How do I clean my liners? A. DAILY: Wash the liner and the residual limb with warm water and a neutral soap or hypoallergenic ph-balanced soap. Use a wash cloth, but do not rub or scrub or you will damage the liner. Rinse well. Wipe the liner dry with a clean dry towel. WEEKLY: Place a small amount of rubbing alcohol on a soft clean cloth. Wipe the liner with the cloth thoroughly, rinse with water, wipe the liner dry with a clean dry towel. Q. Is excessive perspiration normal when I wear my liners? A. Yes, excessive perspiration is normal. It will gradually diminish over period of two to six weeks. You may use antiperspirant, but if a rash develops, discontinue it's use. Q. Can I trim my gel liners? A. We recommend that you contact your practitioner to insure you have proper length for suspension. Q. How do I pay for a prescribed prosthesis (limb) or an orthosis (brace)? A. The first thing is to check to see if you are covered under some type of Private Health Insurance Plan such as through an employer. Insurance coverage alone does not guarantee that a prosthesis or orthosis will be covered under the plan. Plans vary in their procedures, need for prior authorization, and extent of coverage. We can check your insurance plan for you to determine their requirements as well as what they will and will not cover. Often, even when a device is considered a covered item, you may be responsible for paying annual deductibles and co-pays out of your own pocket. Most policies have an annual maximum out-of-pocket, after which they will pay all bills in full. Again, we can help you to check with the insurer to see what, if any, deductibles or co-pays exist. It is important in all cases to keep the Explanation of Benefits (EOB) to know when you meet the deductible. If you have Medicare Part B, they will pay for a portion of your prosthetic and orthotic devices. Generally, Medicare covers 80% of Medicare Allowable, and you or a Secondary Insurance is responsible for the rest. If you have been disabled and receiving disability benefits for at least two years, you are eligible to apply for Medicare Part B. Medicaid has a number of state funded plans. Two examples are Access and Med Plus. The coverage for Orthotics and Prosthetics (O&P) varies widely, and so we would need to check the specific coverage or limitations for you. If you need a prosthesis or orthosis to continue working, or to gain employment, you may meet the criteria for coverage by the Office of Vocational Rehabilitation (OVR). You would need to fill out an application with OVR to see if you meet their criteria for financial need, but if you qualify, they may be able to pay in full or in part for your device. They sometimes help with deductibles and co-pays for persons who have another, primary, insurance. We can put you in touch with an OVR representative if you would like to follow up with this option. Veterans of military service generally have some benefits through the Veterans Administration (VA). The specific level of benefits can vary, and so you would need to check with the VA to see if you can qualify for O&P coverage. The Center has a contract to provide services to veterans who are approved. Under specific circumstances, special programs such as the Area Agency on Aging, the Diabetes Association, the Muscular Dystrophy Association, Easter Seals, United Cerebral Palsy, and the like may be able to help with funding. Generally, if one is applicable to you, you will already be involved with the organization, and can easily check with them as to the availability of any funding for O&P. Occasionally, patients have received financial assistance from local Charitable and Church Organizations. The Center will bill your insurance company directly on your behalf for covered services. You are not required to pay up front for services that are authorized to be covered by insurance, and we will not bill you for any interest or service charges while we wait for the insurance company's payment. We do ask that you assist us as needed by providing any information required to process your claim. And, of course, you are still responsible for all co-pays and deductibles required by your insurer, and any services not covered by insurance. The Center allows you to pay for any services, co-pays and deductibles by credit card. You may call the office with your credit card information for convenience or bring it with you at the time of service. If necessary, we can help you by setting up a payment plan. Q. What is Medical Necessity, and why do I need this? A. Prostheses (limbs) and Orthoses (braces) can only be provided if they are ordered by a physician. In addition to a basic prescription, most third party payers (insurance companies, Medicare, and so forth) require that we send them a copy of a Certificate of Medical Necessity (CMN). The CMN spells out in detail exactly what makes up the device that is being prescribed, and it also explains why it is required from the standpoint of your health needs. The CMN helps to ensure that you get exactly what is needed, … but it is also used by Medicare and other insurance companies to deny payment for items that they feel are not necessary for your health. A simple example would be that it is “medically necessary” to provide a new prosthesis for someone whose current prosthesis no longer fits, is causing them to get sores, or is preventing them from walking the way they should. While it is the physician who must sign the CMN, your Prosthetist or Orthotist will usually need to first submit to your physician our recommendations based on our evaluation of your problems and needs. It is important that you have an appointment with The Center for a consultation so we can discuss your goals and desires, evaluate your physical potential, and together determine the best course of action. We will then contact your physician to make the final determination of what will be ordered. Working together with your practitioner will ultimately provide the best results for you. Q. What is Prior Authorization (Pre-authorization)? A. Some insurers require Prior Authorization of a proposed device prior to work being started. We will help in determining what is to be requested, obtaining the appropriate paperwork from your physician, and submitting the request to your insurer for Prior Authorization by them. We will provide them with all necessary justification to explain why this device is Medically Necessary for you. Then we must all wait for their determination to approve or deny the request. Sometimes we must re-apply and supply them with additional information they request. Usually, this takes less than a week, but with some state funded agencies it can take up to a month or longer to obtain Prior Authorization. Q. What is this CAD/CAM thing that I keep hearing about? A. The term CAD/CAM stands for “Computer Aided Design / Computer Aided Manufacture” and means that we use special computers with advanced software to help us create your artificial limb. First a device scans your residual limb and sends that information to the computer. The computer puts all the measurements and three-dimensional images together to “recreate” your residual limb as a “virtual model” on the monitor screen. Your prosthetist can then tell the computer how to alter this basic model to make it more comfortable and supportive for you to use. This new information (the modified “virtual model”) is sent by the computer to a large carving machine (a kind of complicated lathe) which then carves down a solid block of plastic until it is a solid three dimensional replica of the model created on the computer by your prosthetist. At this point we will use the solid model to make a clear plastic Test Socket. We will attach the Test Socket to a leg for you to walk on in the office during your Fitting. During the Fitting, your prosthetist will make adjustments or changes to the socket to optimize your comfort and support, as well as adjust the rest of the prosthesis to optimize your balance, stability, and ability to walk with the prosthesis. Prior to the availability of the CAD/CAM system (as well as in some instances today) the prosthetist would have to first obtain the “mold” of your residual limb by wrapping it in Plaster of Paris strips. Then we would have to fill that plaster “mold” with liquid plaster. When the liquid plaster had hardened, we would strip away the original “mold” leaving a solid plaster “model”. At this point, the solid plaster model is modified by the practitioner by hand using rasps, knives, a special spatula to apply more plaster, and a sanding screen. A clear plastic Test Socket would be made over this modified model. Both processes result in a Test Socket to be used in a Fitting. The CAD/CAM is a faster method, it is less messy and easier on the patient, and the measurements are very accurate. Finally, while the solid (real) three dimensional models must be destroyed in the fabrication process, the “virtual model” can be saved in the computer indefinitely.