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I am a below knee amputee. More importantly, I am also Mommy to two boys, a very active 10 year old (Robby) and an mischievous toddler (Timmy). I have learned that being a parent with a disability can create some unusual and sometimes humorous situations. This blogger is available for hire! Let's talk and learn how a blog can expand your business.

Tuesday, August 09, 2011

Ready for Battle

Many times I feel like my life as an amputee would be easier if all I had to worry about was phantom limb pain and prosthetics. Instead, I am forced to work within an archaic Workers Compensation system to receive basic prosthetic care. The insurance quagmire is more of a handicap than the lack of my foot and ankle!

I received a notification that my Workman's Compensation carrier would like to settle the claim and offered to fund a "Medicare Set-Aside" account to cover my future medical care. When I examined the numbers I thought that it was a joke. In reality, I underestimated the heartless mentality of the insurance company adjustor!

It is apparent that my adjustor is planning for me to live my life dependent upon a wheelchair. They have allocated funds to purchase seven wheelchairs, nineteen cushions and thirty eight wheelchair tune-ups. I have been generously allocated seven additional knee scooters should I decide to rise out of my wheelchair. I currently have a wheelchair and a knee scooter; both are buried beneath a mountain of outgrown baby clothes in the corner of my basement.

Obviously, my insurance adjustor would prefer I not use a prosthetic. After all, prosthetics are more expensive than wheelchairs. I am allowed only seven prosthetics and sockets for the remainder of my life. I should only replace my prosthetic liner every five years (they have offered to provide seven during the course of my life). The fact that Medicare allows for four liners a year due to hygiene issues is apparently of no concern.

Of course, should my limb become infected because of poor hygiene, I am covered. I have generously been provided with one doctor visit per year, providing that the physician charges no more than $117.49. X-Rays have also been anticipated, but I will have to insist that my doctor take one per year, so he should choose his view wisely. I suppose I will also have to remind my doctor that he should not prescribe more than one pill per year as I have only been allocated with 38 for my lifetime. Let's hope an all-encompassing, super-antibiotic pill costing no more than $24.99 will be invented soon!

Of course, I suppose I could forgo the medication for a few years to create a "stash" to provide a full day of pain medication should the need arise. I am permitted only three limb revision surgeries during my lifetime. My adjustor must have a great deal of confidence in my ability to handle pain because my one pill a year allotment will certainly not provide much relief.

Every morning I wake up and put on my prosthetic, trying to make the best life possible for me and my son. I have accepted that my pre-injury life is over, and I have carved out a new life path. While there is no number great enough to compensate for the loss of my foot, I was infuriated with this paltry offer.

Researching the proposal, I discovered that the numbers were provided by a company called PMSI Settlement Solutions. Their website touts that they will provide the "lowest defensible allocations." (http://www.pmsionline.com/settlement-solutions/msa-services) I wonder if they would put their prosthetic dependent spouse, mother or daughter into a wheelchair because it is cheaper. Hiding behind their computer screens, these figure-fabricating insurance whores actually brag about low-balling medical care for amputees and others with disabilities!

Throughout this process I have become a faceless, soulless entity in the eyes of my insurance company. I am viewed merely as a liability that needs to be written off the books with as little monetary output as possible. My abilities, my aspirations, my lifestyle and my intelligence were never considered.

I have been asked to approve or deny the proposal. As far as I'm concerned, the allocation created by PMSI is nothing more than a gauntlet. Is responding, through fax, with a succinct SCREW YOU clear enough, or perhaps I should just say DENIED as they are wont to do?

I did not ask, nor did I contribute to the accident which caused me to be injured. Given the chance, I would choose to live my life with my natural foot but since that is not possible, I rely upon a prosthetic device to walk. I will accept nothing less than adequate prosthetic care. Perhaps the insurance company underestimating me is my strongest advantage.

To my insurance carrier and to PMSI Settlement Solutions, I say, "Bring it on." This AmputeeMommy is ready for a fight not just for me, but for all of us!


  1. Medicare "Set-Aside?" That's the most ridiculous thing I've ever heard of. You don't get to "set-aside" your limb loss. They don't get to "set-aside" your care. Period. Fight heard, Peggy. If there's ever anything I can do from here, which I know is not likely, I'm happy to help. I'm behind you from here, for what it's worth.

  2. Shamefully ignorant and stupid. In this day and age, we have to get past the insulting idea that amputees not can't have a quality of life but they don't deserve a quality of life. Insurance companies that believe that amputees should not be seen or heard and deserve a life only in a wheelchair or in a bed in a nursing home need to be put out of business. I guess Beth and I were extremely fortunate because we never ran into such problems. Ours were insignificant by comparison. This kind of treatment has to stop. We are inventing products and devices for amputees that there is no market for because insurance won't pay for it. How much cheaper is it to keep you in a wheelchair and possibly unemployed instead of one 2 feet and being a wage-earner, taxpayer, and consumer. Go get'em Peggy. Once again, if there is any way I can be of help, let me know.

  3. They do similar things for anyone who has a chronic illness or chronic condition, meaning one that can't be cured, repaired, or otherwise fixed in a short period of time. The sub-standard care that chronic conditions receive is very detrimental to the patients, and often makes their conditions worse as appropriate treatments (such as proper liner numbers for hygiene and infection safety stated above) are denied.

    It is disgusting. Having a board from the federal government deciding what appropriate care is when Obamacare goes into effect terrifies me.