A fractured foot or leg can be a crippling injury for anyone. It’s not just a physical problem, either. A leg injury can be financially devastating, especially if it interferes with your ability to get to work or take care of your family. For many patients with a leg injury, recovery is a weeks-long process. Depending on the severity of the fracture, you may need to keep weight off your leg, which means no walking. The problem is that some insurance companies don’t cover mobility devices, like crutches, wheelchairs or scooters. In this article, we talk about different types of leg injuries, how to treat them, what medical devices you may need to help during your recovery, and how to get your hands on a cane, crutches or wheelchair without too much hassle from your health insurance company.
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Get your mobility device covered by insurance
Like with medications and medical devices, insurance companies will cover in full or in part the mobility equipment you need, as long as you have a prescription. And in 2021, the American Rescue Plan made it easier to afford health insurance through the Affordable Care Act (ACA). But before putting your credit card down for a $7,000 high-end electric wheelchair, we suggest calling your health insurance company to discuss the particulars of your policy. That’s because most plans will only cover the most basic, least expensive medical equipment. So if you need a specialty device, like hands-free crutches, you’ll either have to pay for it out-of-pocket, or demonstrate to your insurance company why you can’t use an ordinary pair of wood crutches. The same goes for wheelchairs and scooters.
Getting medical equipment covered by insurance is notoriously complicated and confusing. So much so that mobility device companies often have reimbursement specialists or insurance specialists on staff to help customers parse their benefits. They’ll even call health insurance companies for patients outright or will jump in after the patient’s first request is denied.
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Why insurance companies deny claims
Why would an insurance company refuse to cover a wheelchair or walker if you have a broken leg? Apparently, there are dozens of reasons. And even though many customers do appeal the decision and ultimately get coverage for a medical device, many patients will take no for an answer and simply pay out-of-pocket for equipment. Health insurance companies save millions of dollars a year alone from those initial denials. But a fractured leg, even a less serious hairline fracture, is a legit injury that often requires you to use a medical device so that your injury can heal properly. Most patients with a serious leg injury can get coverage for a medical device, and many patients can get partial coverage for higher end devices. It’s just a matter of knowing your rights and the terms of your health insurance benefits.
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Types of Foot and Leg Injuries
There are a few common types of leg fractures. Some breaks are more serious than others, depending on the location of the break, what caused the injury, and whether surrounding tissues sustained damage.
A stress fracture is when you have tiny cracks or severe bruising in the bone. They can be caused by overuse, especially in older patients. They’re also a common injury in sports and athletics, specifically with runners, dancers, soccer and basketball players. Most stress fractures, according to the Cleveland Clinic, occur in the shin bone or tibia. You can also get them in your foot.
With rest and by avoiding activities that can exacerbate your injury, most stress fractures heal on their own. But some patients do need surgery to fasten and hold the bones in place while they recover.
Six to eight weeks, or longer for a more serious injury. “As long as you can feel pain, the bone is still fragile in that area, and could break again in the same place,” according to the Cleveland Clinic. And it’s important to give your foot or leg time to heal because, according to the American Academy of Orthopaedic Surgeons, “Re-injury could lead to chronic problems and the stress fracture might never heal properly.” After about two months, your doctor will suggest gradually returning to normal activities, and maybe evening alternating rest and active days. This will give your bones time to get used to strenuous activity after a long period of inertia.
Most patients with a stress fracture do not need a cane or crutches, much less a wheelchair or scooter. However, older patients and those with repeat injuries, do take longer to heal. Since they should refrain from putting weight on their injured leg or foot, orthopedists suggest using crutches, a cane or a boot.
Walking boots are designed to protect the foot and ankle and keep the bone stable to allow healing. Older patients with stability issues can use a walker or rollator with a seat (a walker on wheels), rather than a cane.
The tibia and fibula are two long bones located in the lower leg, below the knee. The thicker of the two bones, the tibia, is the leg’s main weight-bearing bone. The fibula supports the tibia and provides stabilization for the lower leg and ankle. A low-energy hairline fracture in the lower leg can result from a fall or twisting injury. High-energy hairline fractures can be caused by car accidents or traumatic falls (think teens and skateboards or stunts involving a roof and a swimming pool).
Treating a hairline leg fracture depends on the severity of the break and the age of the patient. For most breaks of this nature, an orthopedist can set the bone without surgery and use a long or short cast to protect the bone.
A traumatic injury may require internally fusing the broken bone with screws and plates; or an external fusion using clamps, rods and pins. Both of these procedures stabilize the fractured bone. A percutaneous pinning is when the orthopedist uses wires to stabilize the broken bone.
Six to eight weeks. For about the first six weeks of recovery, doctors suggest avoiding putting weight onto the affected leg. So patients are encouraged to use crutches for all indoor and outdoor activities. Doctors suggest that older patients use a wheelchair or, if the injury is contained to the lower leg, a knee walker, which affords patients some additional mobility.
If you have a displaced leg fracture, it means the bones are broken in at least two fragments and are not aligned. These injuries are typically caused by a high-energy trauma, like a high-speed car accident, or when a pedestrian is struck by a moving vehicle.
Treating a displaced fracture often requires the orthopedist to surgically set the bone. The surgeon may need to use pins, screws, metal plates or wires to hold broken bones in place. For a break in the middle of the thigh or shin bones, the surgeon can stabilize the bone by positioning a metal rod through the center of the bone.
Recovery can take four to eight weeks and typically requires a cast. The first week or two after surgery, most patients are encouraged to use crutches, a wheelchair or, depending on the location of the injury, a knee scooter. To cope with sleeping while wearing a leg cast, especially for people who prefer sleeping on their side, some doctors suggest using a knee support pillow.
A comminuted fracture means that the bone is shattered into several pieces.
Treating a comminuted fracture often requires surgery to use metal pins or screws to reset the broken bone fragments.
About 12 weeks. Bones recovering from a comminuted fracture should be in a cast and immobile for about two to three months. The leg will likely be in a cast for a majority of that duration. Some patients will need to have their leg in traction so that the bones, muscles and tendons can heal properly and in place. An injury as traumatic as a comminuted fracture requires as much rest as possible. Using a wheelchair or scooter to get around can ensure that happens.
Open or compound fracture
This type of fracture can be complicated because when the bone breaks through the skin, it exposes the patient to bacteria, dirt and contaminants. If the wound becomes infected, it will prolong treatment and recovery. So even before the orthopedist repairs the broken bone, the first step in treating an open fracture is to clean the wound, tissues and bone. Then later, the orthopedist can set the bone and stabilize it.
Compound fractures can be caused by traumatic events, like when vehicles collide, or an injury on the football field or basketball court. You also see compound fractures resulting from gunshots.
After the wound is cleaned, the patient will undergo surgery so the doctor can use rods and pins or metal plates and screws to hold the bone in place. “Since [an open] fracture can also damage the surrounding skin, muscles, nerves and arteries, the doctor will work to repair other tissue damage as well,” according to the University of Pittsburgh Medical Center.
Several months. A compound fracture is a serious injury that can take three months or more to heal. While the bones are setting and healing, doctors recommend that patients use crutches or a wheelchair to avoid putting weight on the bone.
When you have an injury, be sure to see a doctor so that you get the right treatment. If you have insurance through the ACA, then you qualify for coverage. Here are more great deals on orthopedic supplies and devices for arm, back and neck injuries. And learn about health care coverage by reading Decoding Health Insurance and the Alternatives, by health insurance expert, Lauren Jahnke.
Read Decoding Health Insurance
To better understand the U.S. health care system and the options available for all types of workers and earners, check out Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money. You’ll find informative, nonpartisan information and tips for buying health insurance and saving money on health care, whether or not you have coverage.