Gillette Children's is an advocate and works to help children obtain secondary orthotic or prosthetic devices used for sports, physical activities, and bathing.
Playing baseball and golfing with her family are two of the activities 7-year-old Lily Gand is looking forward to now that she has a secondary prosthetic crafted by the Gillette Children’s Orthotics, Prosthetics and Seating (OPS) department.
Lily was born prematurely at 22 weeks and spent the first 155 days of her life in the neonatal intensive care unit. A complication shortly after her birth caused Lily to lose several fingers on her left hand.
Once Lily’s health stabilized her parents, Kari and Tony, took her to see Gillette orthopedic surgeon, Ann Van Heest, MD, to help them understand the best options for Lily’s limb difference.
Dr. Van Heest is an expert in the field of hand and upper extremity orthopedics and is the author of the book “Proud to be Me,” published by Gillette Children’s Health Care Press.
Gillette is home to nationally and internationally recognized leaders in pediatric orthopedics and is helping to lead the way for greater education and advocacy for limb differences.
Gillette Children's Advocacy for "So EveryBODY Can Move" Legislation
Gillette Children’s was a strong advocate for the recently passed “So Every BODY Can Move” legislation that mandates Minnesota insurance plans to cover orthotic and prosthetic devices used for physical activities and bathing—not just those for basic mobility.
Several Gillette families and providers testified before Minnesota lawmakers about the importance of how a secondary prosthetic for sports or bathing increases independence and improves the quality of life for children, teens, and adults who have limb differences.
“Gillette Children’s is literally the only reason we were able to get insurance coverage for Lily’s secondary prosthetic,” her mother, Kari says.
Lily’s orthotics and prosthetics practitioner, Kevin Koenig, helped the Gand family navigate the extensive paperwork needed to get insurance approval for the sports prosthetic.
“Kevin and the insurance appeals team at Gillette are so wonderful,” Kari says. “They really did the bulk of the work to make sure Lily got the prosthetic coverage she needed.”
“The overall support from Gillette was amazing,” Tony adds. “When you need to fight to get options for your child it helps to have the right people around you. That’s what we found at Gillette—the right people.”
Gillette Children’s Expert Orthopedic and Prosthetic Care Helps Lily
Lily’s parents say they’re grateful for the comprehensive care at Gillette and the personal interest the providers have in making sure all children can live their best lives and stay active.
“Lily’s prosthetist, Kevin, was so personally involved in making sure the “So Every BODY Can Move” legislation passed,” Kari recalls. He has great communication skills and really helped to prepare me for the steps I needed to take to get insurance approval for Lily’s prosthetic.”
Kari adds her daughter is also a Kevin fan. “Lily loves to see Kevin and is especially happy when he takes her to the play area at Gillette so he can see her and her prosthetic in action.”
Tony is proud of what his daughter has accomplished and says, “Lily’s defying the odds and making her own path. Having the secondary prosthetic allows Lily to be like her peers. She’s playing catch with her 2-year-old brother, Louie, and is looking forward to joining her extended family at an upcoming golf tournament. I’m glad she can be an active kid.”
What Do I Need to Do to Get a Secondary Prosthesis or Orthosis for Sports or Bathing?
Physician Visit & Prescription
Meet with your physician (or Prosthetics Clinic) for an evaluation of medical necessity and obtain a prescription for the secondary prosthesis or orthosis.
Insurance Check
Contact your insurance company to determine if your policy is Minnesota-regulated. Insurances that are “self-insured” or federally regulated (Tricare, ERISA, VA, etc.) are exempt
Prosthetist Visit
Meet with your prosthetist/orthotist to be evaluated for the prosthesis or orthosis.
Prior Authorization
Your prosthetist/orthotist will request prior authorization to your insurance and Gillette Children’s will work with your insurance to obtain approval. You and your prosthetist/orthotist can proceed after approval is in place.
Fitting
Once your insurance has approved the secondary (sports or bathing) prosthesis or orthosis, then you can proceed with the fitting process with your prosthetist/orthotist.