Dubai: Most health insurance companies are adding to the difficulties of people with prosthetic limbs by not including these conditions in their health policies the cost of the procedures, follow-ups and replacement, when needed.
Luiz Menezes, 43, Brazilian, and Tarek Al Saqqa, 29, are examples of individuals whose insurance does not cover the costs for prosthetic legs. While Menezes is paying the cost on his own, Al Saqqa’s procedure was covered by his employer after he lost his leg in an accident at his workplace.
He is now considering a new prosthesis attachment for his leg after his sports coach encouraged him to take up swimming and cycling more actively. But Menezes is quite certain that he will not get insurance coverage. “I have not tried [getting insurance coverage] but I don’t think it will be accepted anyway,” said Menezes, an aerospace engineer by profession. Menezes has been wearing a prosthetic leg below the knee joint since the age of 11 when he lost his left leg while attempting to catch a train.
Al Saqqa doubts if he will get insurance coverage. “I have not yet tried to see what the insurance covers and what it doesn’t. But chances are that, 99 per cent, it won’t,” said Al Saqqa, a biomedical engineer who lost his right leg below the knee in August 2012 when he was among a team trying to move a 1.3 tonne machine at a hospital. The lead-shielded machine fell on him.
Two weeks later, he underwent a leg amputation surgery. And, eleven months later, he travelled to Germany to attach the prosthetic limb, a procedure his employer paid for.
When he returned to the UAE, his insurance company rejected his request to cover the cost of physiotherapy sessions, because “his situation doesn’t require physiotherapy”, he told Gulf News. He paid for the sessions himself.
Al Saqqa has been using the replacement prosthetic parts he brought with him from Germany. His previous insurance didn’t even cover the labour cost of replacing the pump to remove air so that the prosthetic limb sticks to the leg. He also needs to replace, twice a year, the knee sleeve and the liner to fix the prosthetic part.
Al Saqqa is concerned about who will pay for the replacement parts in the future. He has already spent the last year without any insurance because he changed his job three times after facing difficulties in getting a job, given his situation. “Many companies have a limited view of employing an engineer with one leg,” he added.
Finally, he got a job and, after submitting many reports and documents, received a health insurance card from AXA insurance company.
“When prosthesis is an integral part of a surgical procedure, AXA covers its expenses yet our policy excludes external prosthesis,” Sherif Adel Mahmoud, Regional Head of healthcare operations at AXA Insurance Gulf, said in an email interview with Gulf News.
Stressing the adoption of rules that align with laws of insurance in the UAE as a licenced insurer in the country, Mahmoud added that AXA’s coverage ceiling is usually specified in health policies.
Asked if insurance covers the check-up and replacements when needed, Mahmoud said, “Check-ups of surgical prosthesis are part of the post-care and these are usually covered as well as for the replacements”.
Health insurance policies also specify if congenital conditions are included or not. Accordingly, the treatment of children with deformities can be determined, Mahmoud said.
Asked if governmental health insurance covers prosthetic limbs, Dr Haidar Al Yousuf, Director of Health Funding at Dubai Health Authority (DHA), explained that the recently introduced programme “Sa’adah” (happiness) looks at them on a case-by-case basis.
“In case of limb amputation, we look at it case by case, and if there is a functional requirement, it will be covered. But it won’t be covered if it is for purely cosmetic reasons,” he told Gulf News.
While Sa’adah is limited to UAE nationals, the “Care” health insurance programme covers expatriates working for the public sector.
Care doesn’t cover “prosthetic limbs. Yet, we have not received any request [in this regard]. When we receive requests in rare cases and have specific requirements, we always look at the requirement and we don’t decline in principle,” he added.
There are no figures available about the number of people with prosthetic limbs in UAE or the Arab region.
Meanwhile, the cost is a problem for many who need to attach prosthesis, said Wendelin Lauxen, Managing Director of German Limbtech Orthopaedic Technology, a clinic in Dubai Health Care City that offers many orthopaedic-related services, including prosthetic limbs.
Some people pay by themselves; others through donations from foundations or contributions from television shows. Some insurance companies pay part of the cost, Lauxen told Gulf News.
“But overall, it is still an issue for people, because most insurance [policies] don’t cover this.”
However, Lauxen said, “If you look at it in the long term, it is more costly for the insurance [company], in my experience [of 37 years in the medical field] if you leave a person who is amputated without a leg later on, the condition can be a problem and more surgeries [might become] necessary.”
The cost of a prosthetic limb is determined by several factors, including the kind of amputation, reason for the amputation, conditions of the patient, age, profession, level of sport activity and mobility. The cost could range from Dh23,000 to Dh350,000.
Knowledge and awareness of this issue is important, said Lauxen.