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Financial considerations

Most of us don’t feel comfortable talking about money when our health is at stake: we all want access to medical care with compassion and dignity, and without compromise. How to achieve this is a crucial social question of our time that needs to be approached in the context of what kind of society we want to have. But our aim here is not to address these larger issues, although they are extremely important. Instead we will offer some practical and pragmatic tips on how to approach this matter from the perspective of someone who has recently lost a limb.

Recurring costs

You must take into account that for the rest of your life your prosthesis will have to be adjusted periodically as your body shape changes and the components wear. Also, the mechanical components of a prosthetic leg generally need to be replaced approximately every five years. Obviously, then, you have to include your prosthetis in your financial planning. We recommend that you budget for this just as you would budget for other expenses such as food and electricity.

No standard price

Wayne Derman etch 2“By maintaining a healthy, stable body weight you will have less need for adjustments to your socket, and apart from walking more comfortably and improving your quality of life, you also won’t have to spend as much on regular socket adjustments.”

- Prof Wayne Derman

Typically, the cost of a prosthetic leg can be divided into two parts:

• The manufacturing or labour part as described under what to expect during the making of your prosthesis, which includes designing the socket, and aligning and assembling the components correctly to make sure the complete system works as intended. The more complicated the shape of the residual limb and the more health complications there are, such as scar tissue, the more work and expertise will be required to manufacture the prosthetic leg. Therefore it isn’t possible to estimate a “standard price” for this part of the process, because there is no such thing as a “standard residual limb”, especially when trauma was involved.

• The cost of all the physical components of a prosthetic leg, which the prosthetist obtains from prosthetic device manufacturers. The key factor driving costs here is which components the prosthetist prescribes or recommends. It’s only possible to get an idea of the costs of the prosthetic components once you and the prosthetist have agreed on which ones you will need.

Our advice is: don’t rush into a decision, but take your time and investigate all your options – in other words, be well informed – before you appoint a prosthetist to design your prosthetic leg. It is important to ask why a prosthetist has made a specific recommendation, so that you know exactly why he or she is recommending certain components for you, and what you will be paying for. Once you understand this clearly , you will also be able to understand the differences between quotes from different prosthetists, and ultimately compare apples with apples.

Medical aid

If you are a member of a medical aid, you should enquire about the benefits available as soon as possible, so that you can insist on getting the right treatment early on in your rehabilitation. There are so many different medical aid plans and options that navigating your way through the process can be quite intimidating. Our advice is to get help – and an experienced prosthetist can be just the person you need to guide you through the administrative process required to get a medical aid to authorise payment for your treatment. Be persistent when dealing with your medical aid, and don’t automatically accept it if the fund refuses your first request for a specific prosthesis. Don’t assume that your medical aid simply doesn’t want to help you, but realise that the people making the decisions about payment have a responsibility to pay only for treatments with proven health benefits. Letters from your prosthetist and doctor clearly explaining the health benefits to you of getting a certain prosthetic component often succeed when a case is reviewed by the medical aid. Here it helps if your prosthetist recommends components that have proven their benefits in clinical studies, such as the Flex-Foot family from Össur.

Road Accident Fund

If you were involved in a car accident, you may have a claim for compensation against the Road Accident Fund (RAF). The RAF encourages people who have been injured in a car accident to contact them directly (www.raf.co.za), but it may be worthwhile to get advice from an attorney who specialises in RAF matters. If you succeed with your claim, you may be compensated with a lump-sum payment − but remember that the costs associated with a prosthetic leg can be substantial, so plan and budget carefully for your prosthetics needs as you go forward.

Compensation Fund

Every employer in South Africa is required by law to make a monthly contribution to the Department of Labour
(www.labour.gov.za) Compensation Fund, whose purpose is to compensate people who have been injured at work. If this is what happened in your case, your injury must be reported to the Department of Labour, and you should be able to get funding from the Compensation Fund to pay for medical treatment and a prosthetic leg.

Disability insurance

If you have disability insurance or insurance against the risk of not being able to do your job due to illness or injury, contact your insurance broker to ask about the coverage available. In fact, it’s important for everybody to have sufficient disability cover. Most South Africans are vastly underinsured when it comes to losing a limb. A small adjustment to a person’s insurance policy can mean the difference between being able to afford a suitable prosthesis and having to make do with something inferior.

Fundraising

Never underestimate the willingness of people to help. If done in the right way, fundraising events can be very successful. But your message must be clear, so that people can see why getting the prescribed device will help you lead a productive life. You need to be able to explain exactly what the device will enable you to do and what difference it will make to your health and mobility. This is yet another reason for you to ask questions and be informed about your health and the treatment options available. A letter from your prosthetist or doctor explaining the medical benefits of the specific device they are recommending will go a long way towards getting other people to understand your needs. Remember that most people don’t know a thing about prosthetics, but if they are given a better understanding of what their assistance can do, then contributing to your cause will make more sense to them. This is also a wonderful opportunity to reach out to people and share your story in a creative way − perhaps your first step in making a positive impact on the lives of others.

Something to keep in mind is that if you’ve lost a limb due to an injury at work and the funds available from the Compensation Fund aren’t enough to cover the costs of a prosthetic leg with adequate functionality to allow you to return to work and become a productive employee again, your employer may very well be willing to contribute towards the shortfall. Just think of the benefits to the employer if you can continue with your job and a new employee doesn’t need to be trained from scratch!

The important thing is not to give up when confronted by red tape and other obstacles, and to persist in seeking the treatment you need.

Loan to finance prosthetic components

Most people can’t afford to pay the full amount for a prosthetic leg up front, and often the money from sources such as medical aids or the Compensation Fund isn’t enough to cover the components required. Imagine if no vehicle finance were available and everyone had to pay cash for their car, something that’s surely much less important for mobility than a prosthetic leg! Mobility Assist is a company that was established specifically to meet this need. Depending on your income, monthly expenses and other factors such as the possibility of returning to work, you may qualify for a loan to pay for prosthetic components. But it’s essential that you balance the long-term medical and lifestyle benefits of the prosthetic leg against your ability to afford it, so take the time to investigate your options, draw up a budget, get informed and make wise decisions. If you want to look into this option, please ask your prosthetist to refer you to Mobility Assist.

Public sector

Finally, don’t forget that all South Africans are entitled to treatment at a government medical facility. Find out where the closest provincial orthotics and prosthetics centre is – most major cities in South Africa have one. The differences between private and public health care in South Africa are well known, and prosthetics is no exception. Although the options available in the government sector are fewer than in the private sector, the good news is that prosthetic technology is constantly improving, and components that in the past were only available in the private sector are starting to filter through to public health care. People living with limb loss today have access to better technology in all spheres of society.