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Brian De Herrera

Denied Insurance Coverage Because I was not Diabetic

I currently have Blue Cross insurance. Four years ago, I developed a bacterial infection that nearly took my life. I had three surgeries on my ankle where the debrided it and drilled holes in my bones and put antibiotic beads in the bones. I also have peripheral neuropathy.

After surgery, I needed to have supportive orthoses for both my feet, but insurance would only pay if the brace extended above my ankle. For cosmetic reasons, I did not want to have that brace and only wanted the orthoses to fit in my shoes. After being fitted, I was told that insurance would not cover the orthoses because it was below my ankle. I filed an appeal and lost.

If on the other hand I was diabetic, the same orthotic would have been covered. I find that this double standard is completely unfair. If I have peripheral neuropathy and I am diabetic, insurance would cover it, but since I am not diabetic, insurance would not cover it.

Unfortunately, the bones in my ankle started to die and ultimately I had to have an amputation. I thought it was terrible that the insurance company would not cover the prescribed orthotic. It was definitely a horrible experience. I had multiple doctors write letters as to why I needed the orthotics, but all to no avail. Ultimately, the final appeal was a conference phone call with a committee from the insurance company to either approve or deny the appeal. Not a single person on this decision-making committee was a doctor. The experience was frustrating and finally cost me my limb.