Woman takes on insurance company trying to get advanced prothestic leg
Updated On: Feb 25 2014 06:40:00 PM EST
You can tell Pam Chaney is a fighter by watching her struggle trying to take a step.
Chaney lost her leg to a MRSA infection that developed after knee replacement surgery. She's in physical therapy learning to walk on a very basic prosthetic leg that requires a lot of effort and one that she doesn't feel is safe for her lifestyle.
Chaney says this is the first step in a fight to get the leg she feels she deserves.
"Its harder than I thought it would be because you're controlling this with your buttocks and you're controlling this with your stump," says Chaney.
They're some of the hardest steps Chaney has ever taken.
"The top part feels OK. It's from here down I mean when you look at that, that's a little tiny thing you're stepping on," says Chaney.
This basic prosthetic is the only one her insurance company would approve.
"(My doctor) and my physical therapist both said that I'm going to be walking out of this leg in no time soon. It will be nothing for me. He said the safer, more efficient leg is what I need," said Chaney.
In November, Pam got a letter from United Healthcare denying the more advanced prosthetic her health care providers recommended. The basic leg costs $13,700. The leg she wants is $33,000. The letter from her insurance company reads, "We will not cover any service, treatment, item or supply even it is recommended or prescribed by a physician or is the only available treatment for your condition."
Chaney asked for further explanation and she says she was told it was because of her lifestyle.
"I was not an athlete, or a runner or anything like that, so that leg, would suit me," Chaney said they told her.
It was another blow for a woman who before the amputation says she lived an active life.
"I was doing the grocery shopping and you know being out and about on the town. I mean I was just riding around doing my regular, daily things: laundry and you know. I kept my house spotless," said Chaney.
But now Chaney can't get around the house without help. Her physical therapist comes three times a week.
Chaney is 53 years old, and while she has other health complications, she says age is just a number.
"They don't know me at all," she said of the insurance company. "They act as though, 'This is your age group ,in this little block and this is what we say your activity level is.' I'm going to blow them out the rocker," said Chaney.
Chaney's health care providers have encouraged her to keep working. They told her if she can show she's proficient with this leg, she can appeal the denial from United Healthcare to possibly get approved for the more advanced leg.
In the meantime, her husband just hopes she doesn't get hurt.
"I'm afraid that she's going to fall with this inappropriate leg that she has. I'm looking at her safety," says John Chaney. "It hurts, it hurts real bad. You see someone who was real active then their laying in bed all the time because they can't get up and walk."
For now, Chaney always has someone with her to make sure she doesn't get hurt. Her nurse, husband or physical therapist is always nearby. And no one in this support team is giving up.
"Oh yeah she's going to get that leg and walk. She's going to get up and go and prove the insurance companies wrong," says John Chaney
I started asking questions of United Healthcare in December. I even filled out a release they requested that would allow them to talk about Chaney's case. But they didn't respond to requests for an interview despite multiple follow-up phone calls and emails. The only thing the insurance company did confirm is that Chaney can file a appeal for the leg and they will consider any new circumstances when they get the appeal.
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