ATLANTIC CITY, N.J. — Restoring the natural appearance of a limb or area of the body with silicone prostheses can provide functional benefits for patients and need not be purely cosmetic, according to Leigh Radziwon, owner of SilTec Labs.
Speaking at the New Jersey Chapter of the American Academy of Orthotists and Prosthetists Annual Meeting, Radziwon said that classifying silicone restoration as cosmetic can lead to denials from payers, which in turn can hurt patients.
“The word ‘cosmetic’ is a problem for a few reasons and most importantly it is a stop sign or a red flag for insurance companies,” she said. “When we say, ‘cosmetic finger,’ or ‘cosmetic hand,’ it is literally saying that the only function that this prosthesis is going to provide for a patient is aesthetic — it’s only there to look pretty, that it is non-functional.”
According to Radziwon, the functional benefits of silicone restoration include protection of sensitive areas of the limb, as it acts as a cushion and provides warmth, and that it has a non-porous surface that makes it easy to clean and sterilize.
In addition, silicone prosthetics can help patients regain confidence and self-esteem, promote independence, restore self-perception and, in the case of fingers and hands, regain function in the entire limb, Radziwon said.
She added that patients are often underserved when insurers deny coverage for silicone restoration, as few can afford the high out-of-pocket cost of the devices. As such, patients with amputated fingers or partial hands who do not qualify for robotic prosthetics, are often told there are no other affordable options for care.
“Here is the $1 million question everyone always wants to know: Are these covered under insurance? My answer is: They can be,” she said. “Although everyone’s insurance policy is different, and everyone’s out-of-pocket expense is going to be different, I believe that if we can prove functional necessity for the patient by using one of these devices and we can communicate that — starting with the referral services, the physicians and the office staff — to insurance companies, we have a far greater chance of getting these services at least partially covered.” – by Jason Laday
Reference:
Radziwon L. Functional benefits of silicone restoration devices. Presented at: New Jersey Chapter of the American Academy of Orthotists and Prosthetists Annual Meeting; Nov. 9, 2017; Atlantic City, New Jersey.
Disclosure: Radziwon reports employment with SilTec Labs.
