An orthotic/prosthetic Life Care Plan, sometimes referred to as a Lifetime Care Cost Projection, refers to the estimated cost of care for an individual for a lifetime of orthotic and/or prosthetic services. This is an individualized plan that analyses the cost of ongoing care required due to a catastrophic injury.
Insurance companies and case managers often request this type of information from orthotic and/or prosthetic service providers in order to gauge the overall expected cost incurred on a claim. It is extremely important to provide accurate information based on the consumer’s unique needs.
The role of the orthotic/prosthetic provider preparing information for a Life Care Plan should be to provide specific replacement guidelines, timeframes, and cost for specific orthotic/prosthetic devices and services. Most consumers have a specific Life Care Planner, who reviews all medical costs, including medication, future surgeries, therapy, tests, home assistance, and any other relevant medical care. It is the Life Care Planner’s role to take the information provided by an orthotic/prosthetic provider and relate this cost projection to the consumer’s life expectancy and overall medical needs.
Helpful hints on providing information for a Life Care Plan:
- Time frames should be general and realistic . For example, a prosthetic socket may need to be replaced every two to five years. However, replacement may be required outside of that timeframe if anatomical change, irreparable damage, or if a change in condition occurs.
- Components should be addressed separately . It’s helpful to separately address eachcomponent of the device. For example, the projection for an above knee prosthesis should be separated into (1) the cost of the socket, (2) the cost of the knee, (3) the cost of the foot, and (4) the cost of the protective covering.
- Manufacturer warranties should be included . Many prosthetic components, such as feet and knees, are covered under manufacturer warranties. These warranties vary, but usually cover certain damage for one to two years. These warranties are relevant, but may not apply in certain circumstances. For example, replacement based on a change in condition, or neglect, may not be covered under a manufacturer warranty.
- All supplies should be covered . Providers should submit information on all supplies. For instance, a Life Care Plan for an upper extremity amputee may include replacement of 12-24 prosthetic socks per year, in addition to other component costs.
- The cost of a 'back-up' prosthesis, if medically indicated, should be included . This cost is typically the same as it is for the primary prosthesis. A 'back-up' prosthesis can be utilized when the primary prosthesis requires extensive repair.
- The cost for a 'shower' prosthesis, if medically indicated, should be included . A ‘shower’prosthesis may be particularly useful for a lower extremity amputee, to transfer safely in and out of the shower.
- These figures are only estimations . Nobody can predict the future. A consumer can unexpectedly gain 20 lbs, or obtain new employment that requires an increase in activity level. Additionally, technology is advancing quickly. A Life Care Plan written yesterday will not include the cost for items invented tomorrow. Upgrading components can be expected.
- Non - routine adjustments/repairs may apply . Orthotic/prosthetic providers may charge an hourly rate for non-routine repairs after delivery. These possible costs should be included.
- A 5%-10% increase in component cost should be considered . This increase is in accordance with manufacturer increases in cost.
- These estimations are subject to change .
Again, the key to providing a good Life Care Plan is accurate information based on the individual consumer’s history of care.