Guidelines for How Insurance Coverage and Prior Authorizations Work

So, most of us don’t know how the process of getting supplies, repairs, or even a new orthosis or prosthesis works. This isn’t something to feel badly about, it’s just that we’re all conditioned to think that since we have insurance, everything should just go smoothly! Unfortunately, this isn’t the case in most instances.

Most insurance companies use Medicare guidelines as their own, so this post will directly reference those guidelines. The other aspect we’ll be explaining is prior authorizations, which Medicare does not do but companies like Coordinated Care and Kaiser Permanente do. If you have questions about whether or not your insurance requires prior authorizations, you can always call the customer service number on the back of your insurance card.


For any repair, supply order, or new/replacement device, you need the following:

  • Recent chart notes that reference your need for any of the above. Recent means within the last 6 months and they absolutely have to reference your need for supplies, repair, or new/replacement device.

    • If your notes do not reference your need, your insurance company can refuse payment and even at times can audit the claim. When a claim is audited, they research to make certain all the guidelines have been met. If they have not been met, then the payment is taken back and the patient is then responsible for the cost.

  • Current prescription from your primary care doctor (PCP). An initial RX is good to have on file and we also send them a detailed, Medicare compliant RX/certificate of medical necessity to sign and return after we have seen you.

    • Both the initial RX and the one we send are important. These outline a timeframe for your insurance company to see the need for what we are providing for you.

Once the timeline and need are established, we can continue the process of providing what you’ve asked for. It is essential that these steps are followed to help ensure we’re doing everything we can to lessen the chances of our patients needing to pay for the services out of pocket.

If your insurance is one that requires prior authorization, there is an additional step to the process before we are able to deliver your supplies, complete your repair, or give you the new/replacement device you’ve come in for. That step is as follows:

The 2 steps above must be completed before this one:

  • Once we have both the chart notes from your doctor and the detailed prescription, we then contact your insurance company to start the prior authorization process.

    • This can be over the phone, online, or by filling out a form and faxing it to your insurance company.

  • For all prior authorization requests, all insurance companies require chart notes from your primary care doctor (PCP) and a prescription to be submitted at the same time as the request.

    • Once the request is submitted, the authorization can take up to 2 weeks (sometimes 3 weeks) before we receive either a confirmation or a denial.

  • Upon receipt of authorization, we can then continue the process of completing the repair, filling your supply order, or delivering your new/replacement device.

These steps help ensure that you, the patient, are not stuck with paying out of pocket for what your insurance should be covering. We want to do everything we can to keep your care affordable and consistent.

Changes in the New Year

John writes: 

"It is with much reluctance that I announce my last day practicing at American Artificial Limb will be January 5th, 2018.  Running a small healthcare business the past 8.5 years has been challenging to say the least, but also extremely fulfilling.  This company has given me the opportunity to grow as a clinician in Prosthetics and Orthotics, experiment in design and approach, and positively impact the lives of many patients.  Donn, Erik, and I together have sculpted American Artificial Limb into a modern, friendly, and responsible business that represents our personalities, our caring nature, and our desire to innovate.  I will miss the relationships that have formed here the most as I move on.

Though reluctant, I am also quite excited to start a new extension to my career at Seattle Children’s Hospital.   With two small children of my own, and a need to eliminate the stress of business management, I can now focus more on the well being of my family and use my clinical experience to help children with disability.  My initial year of residency training was in pediatrics, so it feels as though my work has come full circle.

I’d like to extend a sincere thank you to all of my patients who put up with my constant need for conversation and change, and the many healthcare providers with whom I have collaborated.  You have all been so loyal and put so much trust in me over the years.  I have the utmost confidence that you will be well cared for as you continue your Prosthetic and Orthotic relationship with American Artificial Limb Co.  You are in extremely competent hands."


Donn will be covering John's former patients and is also taking new ones at this time. Please feel free to call the office with any questions or concerns about this shift in staffing at AAL. 

Giving Thanks

We are sincerely thankful for our patients, their families, and their care teams. Without you all, there is no us! As Thanksgiving rapidly approaches (tomorrow!), we here at American Artificial Limb are thinking of many things to be thankful for: great food, wonderful friends, a job well done, and the company of loving family (related OR chosen!). Thank you for being a part of our lives and what helps make us successful. 


Perhaps the World Ends Here by Joy Harjo, 1951

The world begins at a kitchen table. No matter what, we must eat to live.

The gifts of earth are brought and prepared, set on the table. So it has been since creation, and it will go on.

We chase chickens or dogs away from it. Babies teethe at the corners. They scrape their knees under it.

It is here that children are given instructions on what it means to be human. We make men at it, we make women.

At this table we gossip, recall enemies and the ghosts of lovers.

Our dreams drink coffee with us as they put their arms around our children. They laugh with us at our poor falling-down selves and as we put ourselves back together once again at the table.

This table has been a house in the rain, an umbrella in the sun.

Wars have begun and ended at this table. It is a place to hide in the shadow of terror. A place to celebrate the terrible victory.

We have given birth on this table, and have prepared our parents for burial here.

At this table we sing with joy, with sorrow. We pray of suffering and remorse. We give thanks.

Perhaps the world will end at the kitchen table, while we are laughing and crying, eating of the last sweet bite.

Resource for New Amputees

It can be overwhelming when you're a new amputee. There are many things to deal with that you've never experienced before and that's before you even get your first prosthesis! We'd like to share a great resource, AmputeeOT. Christina makes fun, informative, and honest videos about her experience as a left below knee amputee. Click below to see how she clears up common misconceptions about getting your first prosthesis.

It's the little things that count, right?

We've been hard at work these last few months, folks! It's been a fantastic summer so far at AAL, with barbecues, birthdays, and amazing PNW sunshine. We've also been fine tuning and tweaking our processes in the office to better serve our patients. 

Speaking of improvements, you may have noticed a new button on the navigation bar at the top of our website. The "Make A Payment" link is brand new and allows you to pay your invoice online instead of mailing a check or calling it in over the phone. Please let us know if you experience any issues with the online payment system- it's a learning curve for us as well!

Alright, gonna get back to the grind. Hope everyone is enjoying the weather just as much as we are!

JRDF- Beat the Bridge!

On 5/21/2017, both John and Melanie will be participating in the Beat the Bridge 8k race! The JRDF (Juvenile Diabetes Research Foundation) works tirelessly to find a cure for Type 1 diabetes. We here at AAL support their work in addition to getting outside and moving! The 8k has a wheelchair division, by the way.  If 8k isn't your thing or seems a little daunting, there's a 3 mile/1 mile fun walk/run to participate in OR you can even virtually attend online to help raise donations. 

Please consider donating to the AAL Team: we're going for a goal of $500! Here's the link: American Artificial Limb Team Donations

Curious as to what the Beat the Bridge run is all about? Don't know what JRDF and T1D stand for? Here's an explanation from their website: 



The Nordstrom Beat the Bridge to Beat Diabetes is a fundraiser for JDRF — the leading global organization funding type 1 diabetes (T1D) research. The event consists of an 8K run and wheelchair race, a 3-mile walk, a 1-mile fun run, and the Diaper Derby for toddlers. The event is called Beat the Bridge because the course travels over Seattle’s University Bridge, which is raised during the race. Participants try to cross the bridge before it is raised. Those who don't beat the bridge must wait, with a live band and entertainment, for the bridge to come back down. After a few minutes, the bridge lowers and everyone can finish the race. Since the first Beat the Bridge race in 1983, Nordstrom has partnered with JDRF to raise funds to cure, prevent and better treat T1D. Beat the Bridge is part of the JDRF One Walk program, which holds annual charitable walks in more than 200 locations in 13 countries. JDRF One Walk has raised more than $1 billion for T1D research and we are proud to currently hold the number one position as the largest Walk in the country! We hope you will join us on May 21, 2017 for the 35th Annual Nordstrom Beat the Bridge to Beat Diabetes.


Type 1 diabetes (T1D) is a chronic, life-threatening autoimmune disease that is currently unpreventable. It has nothing to do with diet or lifestyle and occurs when the immune system mistakenly attacks insulin-producing beta cells within the pancreas and begins killing them off. Eventually the pancreas isn’t able to produce enough insulin to control the blood-sugar spikes that happen after eating. Today, people with T1D rely on insulin therapy to control their blood sugar levels. Insulin therapy is imperfect, however, and even with advances in care, most people still experience life-threatening blood-sugar highs and lows. 1.25 million Americans currently have type 1 diabetes (T1D), and the disease costs about $15 billion each year to treat. Finding ways to prevent this disease is central to saving lives and reducing healthcare costs. With T1D there are no days off, and there is no cure. That's why since 1970, JDRF has sponsored nearly $2 billion in scientific research in 17 countries. We won't stop until we create a world without T1D."


New Year, New Changes

The last few months have just flown by for the team! We've gotten much more comfortable in the new office space, working out scheduling kinks and settling into the flow of a new location.  Even the snow a couple weeks ago barely put a hitch in our stride. 

One big change has happened; Karen has joined the team at Children's Hospital here in Seattle. She'll get to move forward with her career goals of working with families and children in need of prosthetics and orthotics. So, while we will miss her incredible care, professionalism, and dedication at AAL, we wish her all the success in her new position! 

John and Donn are available by appointment to follow up with any of our patients that used to see Karen, so please don't hesitate to call or email. We look forward to continuing to provide the level of care you've come to expect from us here at American Artificial Limb!

Settling into the new space

Shelby and her sweet dog came in yesterday. (That's Melanie, our admin assistant in the background)

Shelby and her sweet dog came in yesterday. (That's Melanie, our admin assistant in the background)

After 4 full days of nothing but moving, organizing, and setting up, we had our first full day in the new space yesterday. Phone calls and faxes were mixed up all of those days, so taking the time to straighten out messages, schedules, and patient calls was extra important! We're set up now and thankfully, all technology is working as it's meant to- including emails and our paperless record system. 

As we move into November, reflecting on how very thankful we are for our patients, co-workers, and the ability to move into a new space is at the front of our minds here at AAL. 

We're so close- November 1st is almost here!

The final countdown begins: 8 days until we're in our new home in Georgetown.

Our new reception desk- check out that snazzy logo!

Our new reception desk- check out that snazzy logo!

Our new front window!

Our new front window!

We can barely believe it ourselves! Moving day is just looming around the corner. Starting November 1st, our wonderful patients will be able to see us at our new location: 650 S Orcas St, Seattle WA 98108.

John, Donn, Erik, and Karen have all been hard at work, setting up the new office, including the new lab area. We're using as many re-purposed items as possible and are very excited about the new space! Keep an eye on our blog for more photos and progress reports. 

AAL Is Moving!

Yes, it's true. After 48 years at our Capitol Hill location, we are moving! This has been long in the making and I'm sure if you've been a long time patient of ours, you know we've been talking about something like this for quite some time. 

The last month has been busy with signing contracts, picking out trim, painting (SO MUCH PAINTING!), and carpet, and ordering/fabricating new office appliances. Our new location will be in the Georgetown neighborhood at 650 S Orcas St, 98108. Suite 100 will be the space we call home! 


Everyone here at American Artificial Limb is so very excited to get into a new space that's built to better serve our patients. We'll still be fabricating prosthetics and orthotics in house in addition to having more room to treat, evaluate, and welcome you. 

The move won't be complete until November 1st and we'll continue seeing patients at our Capitol Hill location at least through the middle of October.