WHAT TO EXPECT WITH YOUR PROSTHETIC PATIENT CARE PROCESS
prosthesis /pros · the · sis/ (pros-the´sis) pl. prosthe´ses [Gr.] an artificial device to replace or augment a missing or impaired part of the body
Handspring wants to make your experience being fitted with a prosthetic device as easy and painless as possible. We are dedicated to you, our patients, and strive to provide the superior patient care that you deserve. Most prosthetic limbs are covered by insurance but there are some exceptions and limitations.
Receiving Your Custom Prosthesis
The following information will help you better understand the process you will go through to get your prosthesis. Our prosthetic care program consists of six basic steps: Evaluation, Authorization, Casting, Diagnostic Fitting, Fit and Delivery, and Follow-up. Usually each visit occurs two weeks apart but your actual visit timing may vary.
It is important to remember that every individual is different and will progress through the process at different rates depending on the severity of injury, prior functional level, and compliance with the treatment program. It can be a challenging journey, but with desire, commitment, and the proper treatment, you can return to the highest level of function possible.
Your doctor will decide when you are sufficiently healed and ready to begin the process. Your prescribing physician will need to have sufficient documentation on file to comply with your insurance company’s policy guidelines. Your physical therapist will also be included in the treatment team to help you learn how to live a normal life despite the loss of a limb.
Visit One — Evaluation
During your first visit, we will gather a wide range of background information from and about you. This includes details like your height, weight, age, prescribing physician, and medical history.
During this visit, we will discuss your functional intentions and plan in detail. We encourage you to be prepared to engage in a conversation about what you would like to accomplish. This conversation will help us to help you. If you have uncertainty about these desires, we are here to provide answers and direction in this self-discovery process.
Some insurance companies require that we get prior authorization before we start the process of creating your custom prosthesis. If this is the case, we will do only the evaluation at this appointment. Once we get the insurance authorization, we will contact you to make an appointment for your Casting Visit.
Once your treatment plan has formalized, we must take a number of administrative steps prior to moving forward with the creation of your prosthesis and moving through the rehabilitation process. The first step includes verifying insurance coverage. With most insurance companies, prosthetic services are listed under the Durable Medical Equipment clause of your policy.
We will work directly with your doctor to create a detailed prescription that will specify the patient care services that you will receive. It is your treating physician’s records, not the prosthetist’s records, which are used to establish medical necessity by insurance payers. The more quickly this information can be provided to us by your physician, the faster your prosthetic process will be. Without your physician’s record about you, we will be unable to make your prosthesis. We will be requesting the following information from your physician before starting the prosthetic process:
- Gather the full history of your amputation
- Quantitatively assess your functional potential
- Review of your desire to be active in your daily life
- Evaluate the current condition of the limb
Once the necessary documentation is collected, we will submit an authorization request to your insurance company (if required). The time needed to review the information varies with each payer and can take anywhere from a few days to a few weeks. In the event of a denial of authorization, we will make every effort to appeal the insurance payer’s decision on your behalf.
As part of our commitment of service to you, we will verify your prosthetic coverage and review the information with you. However, insurance authorization is not a guarantee of full payment by the insurance company. As a result of this process, our office will provide you with a preliminary estimate of the costs of these prosthetic services and how they will be split between the insurance company and you. Your patient payment portion is subject to change based on final claim determination by your insurance carrier.
Visit Two — Casting
As the next step, we will evaluate your residual limb for any prominent bones, sensitive areas, and swelling. After this review, we will capture the shape of your limb either using plaster to "cast" the shape of your limb or we will use our Computer Aided Design (CAD) system to digitally capture the shape details of your residual limb. It is very important that your limb not be swollen when we take a cast to make the socket. If you are swollen, you will need to wear a fabric "shrinkers" to help remove fluid from your limb and we will need to make another appointment for the casting of your residual limb.
If your limb is at a consistent volume, and we have verified your insurance coverage, we will take very detailed measurements of your residual limb and capture your limb shape through casting. We will also take measurements of your sound limb to make sure the height of the prosthesis is accurate. These details will allow us to design and create a prosthetic socket that is customized to your specific anatomy.
Visit Three — Initial Fitting and Alignment
Based upon your individual cast, we will create a "check socket" that matches the shape of your residual limb. The check socket is a clear, plastic socket that allows your clinician to determine the fit of the prosthesis on your residual limb. Achieving the correct fit of the socket is critical to assisting an amputee to live the most active life possible.
Please bring any daily work or living devices that you use routinely to this appointment. The more you share with your prosthetist about what you do on a daily basis and what you have challenges accomplishing, the better your prosthetist will be able to provide you with a prosthesis that meets your functional needs.
Depending on the situations encountered during this appointment, you might need another check socket made to optimize your results. If this occurs, you will need to have an additional visit.
Visit Four — Fitting and Delivery
During this appointment, you will be fit with your new, final prosthesis that you will be taking home to use every day. As a part of this process, you will likely be given either a supply of liner interfaces and/or a supply of prosthetic socks. In addition, your prosthetist will spend time with you to be sure that you are educated on the proper donning of your prosthesis, how to use the features of your complete prosthetic device, provided with introductory usage training, and how to determine if your socket is no longer fitting well.
If this is your first prosthesis, do not expect to wear your new prosthesis all of the time right away. We recommend wearing your custom device for 1-3 hours the first day and gradually increasing the wear time by an hour each day. You should check the skin on your residual limb often for signs of irritation or redness. Redness over a large area that dissipates after removal of the prosthesis is usually normal. If you have localized redness caused by pressure, please contact our facility for an appointment so that changes to the prosthesis can be made.
Our practitioners will provide you with initial daily use training to help you to begin to do other daily activities while wearing your prosthesis. However, additional support is recommended for first time prosthetic wearers, so we will recommend that you begin to work immediately with a local physical or occupational therapist.
If you begin to experience discomfort, remember that your definitive prosthesis has not changed. It is more likely that your residual limb has undergone a physical change. Your prosthesis was designed to fit your residual limb’s unique shape. If your limb is not in the socket properly or if the shape of your residual limb has changed, it can be uncomfortable. Often this discomfort can be relieved by adding or removing prosthetic socks or padding.
Follow Up Visits
Your first Follow Up appointment will be scheduled for 1-2 weeks after the delivery of your definitive prosthesis. Follow Up appointments will allow your clinician to continue assessing the fit and function of your new prosthesis as you begin to use it and your activity levels change over time. During these appointments, we will discuss what may or may not be working for you, and we will make necessary changes to ensure your comfort and satisfaction.