Will Kaiser health insurance pay for a knee brace? Subsidize it?

October 16, 2009 11:25 AM

Will Kaiser health insurance pay for a knee brace? Subsidize it?

I had an ACL operation two years ago (two replacements, actually) while insured by Aetna. My doctor told me the insurance would help pay for a functional brace, but that I should wait a few months to let my muscles grow again.

Two years later, I have insurance with Kaiser, and I am only now returning to full activity. Do you think there's any chance they'll help subsidize the cost of a CTi brace or equivalent? Will this prior condition not be covered? Anyone have experience in this department?

Thanks!

posted by jstef to health & fitness (5 comments total)

It really depends on your particular policy; believe it or not, there's not even one standard Kaiser policy...just call HR or get a copy of your health plan document (known as the summary plan description) from HR.

Either way you should be able to get an answer quickly. Something like this is classified as durable medical equipment, I think.
posted by bananafish at 11:29 AM on October 16, 2009

I wouldn't be surprised if they do pay for it. Talk to your doctor or call the number on your Kaiser card and just ask if your plan covers it. I've found Kaiser to be supportive of things thought of as preventative, and a brace would fall into that category, I believe.
posted by incessant at 11:42 AM on October 16, 2009

Is there a chance? Sure. The best way to know, though, is to go see a doc at a Kaiser facility and ask about whether a functional brace makes sense for you to use. I imagine you'll have to go see your primary care doc first to get a referral, but I've never had a problem getting referrals to specialists.

In my experience, Kaiser often covers things that other insurance companies don't (for instance, they're the only insurers in the DC area who cover travel vaccinations). My guess is that's because they're set up as a hybrid insurance company / doctor organization--the Kaiser Permanente Medical Group actually bears the financial risk, and they're the same ones who you go see when you get sick. So (again, in my experience) it's never really a situation where you go out and buy something on your own, and submit receipts to get reimbursed like you would for a plain-vanilla insurance company. If you need something, they provide it to you directly, through their pharmacies or their own durable medical equipment suppliers--after they've had one of their docs look at you and decide that it's medically necessary.

As an added bonus, you can have someone with an MD evaluate how your knee is doing, and whether a brace is the best solution or whether something else (physical therapy, etc) will actually strengthen it more.
posted by iminurmefi at 11:52 AM on October 16, 2009

Over the years, Kaiser has provided me with a back brace, a cane, and a pair of crutches, all at zero out-of-pocket cost to me.
posted by Lexica at 9:08 PM on October 16, 2009

After an appointment and follow-up (and free vaccines), I found out that my brace was covered. Kaiser sent a DonJoy representative out to my house to measure up my leg and they are making the brace as we speak.

My PA wasn't too knowledgeable about the process, but she found out that braces were covered for all post-op ACL replacements. I wish they would publish this information somewhere. But, pretty cool! Thanks everybody.
posted by jstef at 9:35 AM on November 18, 2009