What Patients Should Know About Choosing Insurance
Insurance decisions can have a major impact on rehabilitation access, especially for older adults navigating Medicare. Linsey often sees patients choose replacement plans with lower monthly premiums, only to later discover that these plans provide far less rehabilitation coverage than traditional Medicare.
“A lot of patients don’t realize the difference,” she explains. “Someone might be in their seventies or eighties, fall and break their hip, and suddenly the replacement plan only allows two weeks in rehab - when traditional Medicare might allow sixty to ninety days.”
Before selecting or changing an insurance plan, Linsey recommends asking specific questions about your current and anticipated needs. Start by asking what the coverage is for your current issues - and be specific. Say that you’re a limb loss patient, that you need a new prosthesis every few years, that you require ongoing therapy. Follow that with questions about rehabilitation coverage: inpatient rehab days, outpatient therapy visits, and whether prior authorisation is required. And ask about deductibles for devices and therapy specifically - a plan with a low monthly premium but a $5,000 deductible may cost far more in the long run.
Don’t accept vague assurances that a plan covers “just like Medicare.” For rehabilitation specifically, replacement plans often fall significantly short. Get the answers in writing before making any changes.
For a full breakdown of how therapy authorisation works once you’re covered - including benefits checks, evaluations, prior authorisation, recertification, and reauthorisation - see Part 5 - How Therapy Gets Authorized.
Becoming Your Own Advocate
Much of the insurance process is handled by clinics and prosthetic providers on behalf of patients - and in most cases, that’s appropriate, because the administrative complexity is genuinely overwhelming. But there are situations where patients need to step in and advocate for themselves.
When a denial comes through, the most powerful thing you can do is ask a simple question: why? Why was this denied? What specific criteria weren’t met? What documentation would change the decision?
Linsey is candid that insurers don’t always have good answers. “A lot of times the insurance companies don’t know how to answer those questions. Every time you call and get somebody new, they’re going to give you a different answer.” That’s frustrating - but it also means persistence matters. Keep calling. Keep asking. Take notes during every conversation and save records of every approval or denial.
If you’re fighting a denial, gather everything you can: clinical notes from your prosthetist, therapy documentation, letters from your doctors explaining the functional impact on your daily life. And don’t be afraid to escalate. Some physicians are now moving into roles reviewing approvals and denials for insurers - specifically because they’ve seen too many unjust decisions from the clinical side. As Linsey puts it, they’re stepping in and saying, “I’m going to make this difference because other people aren’t.” The tide is slowly turning.
Advocacy can be exhausting. But it is often the only thing that works.
Final Thoughts
Finding the right care after limb loss involves more than finding a clinic that’s nearby and takes your insurance. It means finding a therapist who sees you, who understands your device, and who will fight for you when something isn’t right. It means understanding your insurance well enough to avoid nasty surprises. And it means being willing to advocate for yourself when the system falls short - because it will, more often than it should.
As Linsey reminds patients: “There’s no wrong question. Just ask the questions.”
Linsey Porter is an occupational therapy assistant with nearly 12 years of experience across inpatient rehabilitation, skilled nursing, telehealth, and billing and coding. She is based in Northwest Indiana and currently works with Restorative Health, building a specialised therapy programme that integrates prosthetic and orthotic expertise directly into the rehabilitation process.