| Prosthetics & Insurance Coverage
In the previous essay, 'No Toes & Faux Toes', I wrote about dealing with the long-term effects of the loss of a toe, I discussed the options that are available regarding prosthetic toes. Even all these years later, I receive at least a dozen emails each week from people eager and anxious to find out where they can get a "faux-toe." And while I'm always very happy to help out in any way that I can, I think it's about time I update this site with information to answer just that question.
Before we get too far into the details, I think it's vitally important that we address your expectations. Nearly everyone I speak to immediately brings up the thought, "People who have lost legs can run again thanks to prosthetics; I'm sure they'll solve all my problems too!"
There is a vast difference between the prosthetics created to replace limbs and the small prosthetics that are available to toe amputees. The most significant of those differences is in regard to its functionality. While there is a great deal that can be done to address the needs of an amputee who has lost an entire limb, there just isn't much that can be done to address the needs of a toe amputee.
The prosthetic toe that was made for me had no inner construction, it had no underlying support structure, and it does not do anything to alleviate difficulties with weight-bearing, stress on the other toes, or balance. It's not that I got a subpar prosthetic - far from it. I actually got one of the best prosthetic toes available. It's just that in the space of an inch at the end of your foot, modern science just can't provide anything that will make up for the loss of a body part. Although our toes are small in size, the toes we were born with carried out a variety of vital functions. But nothing man can create can make up for the loss of your toes and you will be sorely disappointed if you go into this process expecting someone else to create a toe that's even a tenth as effective as the toe you lost. I know it's not exactly a comforting thought, but in order to find a successful solution, we must have realistic expectations.
The first stage in getting a prosthetic toe is knowing how and where to find the experts who make them. As I mentioned in the previous essay, the man who created my toe was Mr. Robert Barron. I know a lot of you have contacted him, but unfortunately due to his incredibly busy schedule, he no longer creates prosthetics to replace toes or fingers. But don't worry - he's not the only person around who can create accurate and visually appealing recreations of toes.
My prosthetic toe was created by Mr Robert Barron. A lot of you have contacted him, but unfortunately due to his incredibly busy schedule, he no longer creates prosthetics for the toes or fingers. But don't worry - he's not the only person around who can create accurate recreations of toes. The trick is, how to find the rest of the people out there in the world like Mr. Barron.
It's really not as tricky as it may seem; the key is finding the right specialty to search for. If you tried googling "prosthetics" you'd probably only find those specialists who create larger, functional prosthetics that don't exactly look life-like. While there's definitely a need for such prosthetics experts, they don't exactly address our needs. What we need to find is someone who's more of an artist, an expert who can take silicon and turn it into a lifelike recreation of the toe(s) that we lost.
For that, you need to find an Anaplastologist. That's the name for the subspecialty of prosthetics that deals entirely with smaller, non-functional, "cosmetic" prosthetics. Their training is typically in the arts, which allows them to create prosthetics that are more akin to those used on movie sets than in orthopedic wards. And that's exactly what we need for our toes.
Try googling "Anaplastologist" or "Anaplastology" and see if you can find any in your area. If that doesn't work, try calling a couple prosthetics suppliers in your area and ask them for a referral to an Anaplastologist. Most major prosthetics offices will either have one in their staff or know where you can find one. Another option would be to speak to an Orthopedic surgeon, preferably at a teaching or university hospital, and again, ask them for a referral to an Anaplastologist.
I'll do my best to develop a database of Anaplastology offices in a variety of ages, but due to ongoing illness it may be some time before it's completed.
The creation of these toes can become quite expensive, and while most insurance companies will not cover prosthetics that are deemed typically cosmetic, there is a way to apply for coverage in this case. My insurance company paid for half of my toe and with some persistence and dedication, you might be able to convince your insurance company to do the same.
The way to win over an insurance company is to prove there is a medical necessity for your prosthetic toe. In my case, I had a terrible problem with stubbing my toes even before my toe was amputated. When someone stubs their toe, it hurts, but there's nothing too inherently dangerous about it. When a toe amputee stubs their stump, however, there can be significant risk involved. Because there isn't much flesh around the end of the stump, the exposed bone is only surrounded by the skin. This doesn't provide much of a buffer zone to absorb the force of an impact, which can lead to serious injury. Toe amputees are at a greater risk for broken bones, as the weight distribution of the foot is significantly altered after the loss of a toe. When your stump gets rammed into a solid surface, that force gets transferred up through the bones in the foot, and often, even ends up going into the ankle. This can lead to all sorts of difficulties, including serious fractures. Where the toe might have provided a bit of protection, without that toe, your foot is vulnerable.
This is where a silicon prosthetic toe will come in handy and provide some protection for the exposed stump. After the amputation of my toe I had several incidents where I'd sprain my ankle due to stubbing my stump. The pain was so intense and unbearable and sometimes lasted for weeks. My doctors were concerned about this, and when we eventually decided to look into getting a prosthetic toe, it was to address more than just emotional difficulties.
If you're having similar problems or if you have already experienced fractures of the bones of your feet, you need to seriously consider talking to your doctor about a prosthetic toe. And this can be exactly the reason for medical necessity that your insurance company needs in order to approve coverage of a prosthetic toe.
The idea is this - an insurance company will pay for something if it will help to avoid any future costs in medical care. If you stub your stump and break your foot, the medical costs will be astronomical. If, however, before that happened they could spend $2,000 for a prosthetic toe that increases your chances of avoiding such a fracture, then that's money well spent.
But how do you go about making this happen? The first step is to talk to your doctor and determine if this is really something that will benefit your medical care. If your doctor agrees, then you can ask your doctor to write a letter explaining medical necessity. They must explain what has happened, the "medical necessity" of the prosthetic (be sure they include those exact words - "medical necessity"), and the risk of continuing to leave the stump exposed. The doctor then signs the letter, makes a copy for your records, and then you mail the letter to the insurance company.
Because insurance companies are big, however, and if you just mail it blindly to the main office, it's far too likely that your letter will get lost in the shuffle. Before mailing it, contact your insurance company and ask for the office of the Medical Review Board. Explain to them that you're asking for coverage for a prosthetic toe, and make sure that it is indeed that office that you will send your letter and request to.
If you want to further bolster your case, you might want to have additional doctors write similar letters of medical necessity. I'd recommend an Orthopedic Surgeon as well as a Podiatrist. Be sure to send all of that in at once to avoid confusion, and make sure you keep copies of the letters on hand and in your medical records.
Don't be surprised if your request gets denied, even multiple times. This is where that dedication is so vitally important. You have the right of appeal, so continue to talk with your insurance company. But please, be sure to stay as calm, polite, and professional at all times. Getting angry and shouting at whoever you happen to get on the phone isn't going to help your case. Be persistent, ask what you can do to help the case along, and remember to be patient. It took several months before my insurance company agreed to cover part of the cost of the toe, but it was well worth it.
I hope this has been of some help, and as always, if you have any questions, feel free to email me. Good luck!
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