Do most insurance companies pay for microprocessor knees?

Microprocessor knees are a covered item by Medicare, the Veterans Administration and the majority of insurance companies nationwide.  There are a small number of insurance companies that have adopted a policy that states that they do not pay for a microprocessor knee. It is important for you to check the language of your specific policy to understand what is covered and what is not a covered benefit.

What is required to qualify for a microprocessor knee?

First and foremost you must be a qualified candidate for this technology (above knee amputee and a healthy individual capable of walking with prosthesis).  You must also obtain a detailed prescription from a medical doctor and it is also helpful to also obtain a Letter of Medical Necessity (LMN) from the medical doctor.

And most importantly you must meet the criteria of your insurance company’s definition of “medical necessity” for a microprocessor knee.  Each insurance company has a detailed definition of what is considered “medically necessary”; you must clearly meet each requisite of this definition in order to qualify for coverage.

Does Medicare pay for a microprocessor knee?

Medicare does provide benefits for a microprocessor knee, but you must first meet the Medicare criteria and be a qualified candidate and have a detailed signed prescription from a qualified medical doctor.

Is a prior authorization process required?

For many insurance companies, prior authorization may be required before a microprocessor knee can be provided.  This process is to determine if the insurance company will cover the microprocessor as a benefit before it is provided.  Therefore, it is highly recommended to work directly with a prosthetic provider that has experience with microprocessor knees to ensure the process is done correctly to avoid delays and mistakes.  Prior authorization can be a time consuming and bureaucratic process, it will save you a lot of time and frustration by working with someone that is familiar with the process.