The limb different community can sometimes unfortunately face roadblocks set forth by insurance companies for access to the tools they deserve to live adaptive lives. It is not uncommon for those seeking a bionic prosthesis to have to prove it is medically necessary, trial a less advanced prosthesis first, or encounter other negative reasons as to why their access to life changing technology is being gate-kept.
Such was the case recently for North Carolina resident and amputee Benjamin Nunn, who endured a challenge with his insurance company for an Open Bionics Hero Arm, a multi-grip myoelectic bionic prosthesis. After an initial denial, Ben worked closely with his clinicians at Limbionics to appeal the denial. Thankfully, Ben won his appeal and was just fit with his brand-new Hero Arm! While insurance denials can happen, it’s success stories like Ben’s that motivates us to continue the work of assisting potential Hero Arm candidates when and where we can. Open Bionics took time to chat with Ben about his experience and what he’s been using his new Hero Arm for so far.
Q: Can you please introduce yourself so our readers can get to know you?
A: I’m Ben, I’m from North Carolina. I’m married, I have two kids who now have kids of their own! I was a career biomedical technician, so I worked on medical equipment from 1982 through to about 2022.
Q: Can you share how you became limb different and how that changed things for you?
A: During that time, I had a problem with giant cell tumours. It kept occurring just in my right hand – each time worse and bigger. At the time of the first amputation, they had removed two fingers. It came back again on my wrist, and it came back big and quick. After a discussion, we decided on a full amputation. This was in February of 2023.
Q: What did your recovery look like after the amputation?
A: I let it heal up, went through the process of looking around, and being a bio med tech, I was already really interested in cutting edge technology. When I came across the Hero Arm, I was impressed at it being 3D printed and custom fit for me. I found out about the carbon fiber wires that are used in the fingers and was impressed by that.
Q: And how did your clinical journey begin to get the Hero Arm, we understand you had some hiccups with insurance along the way?
A: Yes – it was a bit of a struggle. We started in June of 2023, and I was told at that time that I was approved and that everything was great. When I went in for my fitting, I was then told “We’re sorry, you’re not approved.” After a lengthy process, I finally appealed that decision myself and found out that the clinic I was working with at the time wasn’t certified on providing DME (durable medical equipment), which is what the insurance fixated on.
Q: What did you do from there?
A: Through my own research, I found Limbionics and started working with them. Again, our first attempt to get it approved didn’t work – it was deemed ‘not medically necessary.’ The second time, I had my local physician write a recommendation for me. Finally, it went through and I was approved and the appeal let go. I also found out that BCBS paid my claims.
Q: That is so relieving to hear. We are so glad you finally got your approval! How was the fitting process with Limbionics?
A: The placement is perfect. My prosthetist Zoe did an amazing job getting the sensors just in the right spot. Once I get things going with practice it just works so well. It gives me the ability to do all the finger grips, I’m getting really good at it. This is my arm now, and I’ve been having a blast.
Q: What are your thoughts now that you finally have it and have been incorporating it into your daily routine?
A: I still go to the hospital to deal with a few minor tumours, but all the staff there are amazed by it. I wore it there for my last appointment and the entire phlebotomy staff wanted to see it and touch it. My grandkids love it too, my grandson keeps giving me high fives. Everywhere I go, even into the local grocery store, I’m telling people “Check this out”, and people are like “WOW!”
Q: What are you finding that you like best about it so far?
A: I’ve been finding that I can pick up smaller objects, and from a practical standpoint I can pick up water bottles and hold them while I twist them open, which was next to impossible before. Carrying grocery bags, holding my toothbrush to put toothpaste on it.
Q: What else do you love about your new Hero Arm so far?
A: It just molds together so beautifully. It’s really a work of art. Especially the vortex cover pattern, I really love it. Sometimes I catch it in the mirror and I say “Wow, that looks really cool!”
Open Bionics is proud to provide more and more people in the limb different community the tools they want to live adaptive lives. We are pleased that Ben was able to not back down from his unfortunate insurance experience and ultimately gain approval for the device that he wanted. It’s high time that more insurance companies listened to the actual users and became their allies rather than a hurdle in the path of their bionic journey. We can’t wait to keep up with Ben and see just what he uses his Hero Arm for next.
If you’re interested in a Hero Arm of your very own, please fill out the form linked here and we will not only be in touch with you, but also your advocate and ally along the way. To help ease your concerns about our relationships with insurance, Open Bionics has had success with Blue Cross Blue Shield, United Healthcare, Cigna, Medicaid & Medicare, and Humana, among others.
The Hero Arm uses myoelectric sensors which detect underlying muscular contractions generated from specific muscle groups in the arm. These are then amplified and converted into intuitive and proportional bionic hand movements. Each Hero Arm is custom-built for optimal comfort, and fits like a glove.