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Insurance Providers

It is important for insurers to recognize that prostheses are not ‘durable medical equipment’, they are the patient’s limb.  There is no prosthesis that can replicate the movements of the original human limb or replace the functionality to the degree the human limb provided.

 

Certified Prosthetists are uniquely trained to help amputees live independent, active and productive lives.  The goals of prosthetic treatment are to optimize independence, quality of life and body image for each individual amputee. Only the CP(c) can match a specific limb prosthesis and all its component parts to an individual patient’s unique clinical needs.

 

A CP(c)’s knowledge of anatomy, physiology, physics, pathology, biomechanics and other areas forms the broad foundation upon which their specialty is based.  Prostheses are complex devices. Prosthetic treatments merge science, art, engineering and health care knowledge.

 

Access to funding is the most challenging aspect of prosthetic treatment for the patient and the Certified Prosthetist.  Early and appropriate prosthetic treatment save costs for payers by allowing patients to exit the health care system sooner, avoid long term disability, prevent co-morbidities (and the costs associated with them) and return to independent living and work.

 

Certified Prosthetists CP(c) have been credentialed in Canada for over 50 years.  There are approximately 500 Certified Orthotists/Prosthetists in Canada.  Only those professionals that have been CBCPO credentialed through OPC can use the Certified Orthotist CO(c) or Certified Prosthetist CP(c) titles.

 

To find a Certified Prosthetist near you, use our Find A Professional feature.  Only credentialed and active professionals appear on the Find A Professional site.  If you have any questions, please contact OPC at 613-595-1919 ext. 1 or via email at info@opcanada.ca.

Prosthetics and Insurance Policies

OPC wants to work with insurance companies to ensure the most appropriate treatment for each individual patient can be realized.  There are currently a number of concerns that can be seen within insurance claims policies that have existed in perpetuity that lack common sense, are not consistent with the most appropriate treatment and fall short of humanitarian obligations.

How Insurance Companies Can Provide Patients with the most appropriate and cost-effective care:

  1. Recognize appropriate expertise – recognize Certified Orthotists and Certified Prosthetists in claims policy for the uniquely trained and specialized health professionals they are. Insurance companies need to remove the unintended discrimination of only recognizing regulated health professions in its policies.  Certified Prosthetists and Certified Orthotists are not regulated in any province (outside of Quebec) because they do not have sufficient numbers to form a regulatory college in any Province.  However, they are recognized healthcare specialists with unique training not possessed by any other health professionals.

 

  1. Revise archaic policy wording - “One limb for life”, “Usual and customary costs”, “least cost option” are all examples of inappropriate wording that does not recognize the unique treatment requirements for each patient and the value of the most appropriate treatments. The most appropriate prosthesis for a patient can range from a very basic manual prosthesis to a prosthesis with electronic microprocessors.  The most appropriate prosthesis, as determined by the Certified Prosthetist following the patient assessment and evaluation, is based on the patient’s physical capabilities, daily living requirements and more.  The most appropriate prosthesis is patient specific that allows them to:
    • lead independent lives,
    • manage daily living needs
    • provide enhance safety
    • facilitate mobility and capability

 

  1. Recognize the cost effectiveness of early and appropriate prosthetic treatment – Yes, the most appropriate prosthesis can present significant upfront costs. Insurers need to realize that only 1% of the population in Canada require prosthetics.  Therefore, it is a very small patient cohort.  The upfront costs should be amortized over a five to six-year period (manufacturer warranty), depending on the age of the patient (children will need replacement prostheses more often).  There are many treatments that insurance companies fund that are much more expensive than the amortized cost for a prosthesis.

 

  1. Support assignment of benefits (direct billing) – The upfront costs to obtain the most appropriate prosthesis can be considerable. Most amputees are unable to pay for those costs to obtain the prosthesis.  Unfortunately, many insurance companies refuse to allow direct billing and require the patient to pay upfront for the prosthesis, before the claim can be submitted.  This is inhumane given that the amputee must manage the trauma and new realities thrust upon them and then to be refused the prosthesis that will allow them to cope based on administrative requirements.  We can do better.

 

  1. Support OPC’s efforts to improve public funding – OPC wants to see better public funding for treatments that address limb loss. By supporting our efforts for improving public funding, the burden on private health insurance funding is reduced.

 

It is important to understand that a Certified Prosthetist CP(c) is ethically bound to treat and fit an amputee with only the prosthetic devices that are appropriate for the patient to achieve independence, safety, comfort and improve function.  Providing prostheses for amputees is the core function for Certified Prosthetists and they should be recognized as the specialized healthcare professionals they are.