You are here

Medical Insurance

Some of you might be interested in this information when choosing medical insurance. It is stuff that I have gathered from personal experience.

1. Doctor & Hospital: Decide who you think you want your child’s surgeon/doctor to be. Make sure that the insurance you choose lists that doctor and the hospital he/she works at as "in network".

2. Durable Medical Equipment (DME): Check the DME coverage for the insurance. (DME is stuff like prosthetics, orthotics, walkers and wheelchairs.) Some pay a percentage of the bill. Some require you to pay a copay. My daughter's first prosthesis cost about $4,000.00. Insurance covered 90% of the bill, but that still left us with $400.00 to pay our self. We now have insurance that has us to pay $100.00 maximum per year per family member for DMEs.

3. Physical Therapy (PT): Check the physical therapy coverage. Some limit the number of PT appointments. Some charge a fee for each PT appointment. Ours is $15.00 per PT visit with a maximum of 60 visits per year. After that we pay 100%. I called a local physical therapy place and they charge over $300.00/hour if you do not have insurance coverage. I don’t believe that all places are this expensive, but you will want to do research before you commit to a place. Quality of care received is just as important as how much they charge. My brother went to a physical therapist to help with a problem he was having and they ended up doing more harm than good. Physical therapy is key to proper recovery.

4. Shriner's Hospital or other free hospital: See if there is a Shriner's Hospital relatively close to you. Shriner's is a FREE hospital for children with orthopedic problems. They do surgery, therapy, and make prosthetics for children with PFFD, among other reasons. For financial reasons, my daughter gets her PT and prosthetics done at Shriner’s in Philadelphia. It takes us 1 to 1.5 hours each way to get there, but it's well worth it. The staff is great and we don't have to pay anything. We still have her surgeries done at a non-Shriner's Hospital (Children's Hospital in Philadelphia) just because our insurance covers it and we absolutely love it there. But if our insurance would ever drop coverage at CHOP, we would switch completely over to Shriner’s. You have to apply to get your child treated at Shriner’s, but it's not that bad. I think that there are other free hospitals across the nation that provide similar services as Shriner’s, but I don’t have any specific knowledge of those hospitals.

I hope this helps. If I have stated something incorrect, please correct me. If you feel that you can add to the list, please do.



We are recently going through some issues with Cigna. My husband's company changed insurance companies on us from BCBS to Cigna. We didn't check the exclusions in the policy, not that we had much choice, but found that Cigna will cover just about everything that our son needs for his bilateral pffd except for the shoe lift that he needs to walk properly with. We are in an appeals process right now to get Cigna to pay for his shoe lifts.