Responses to "C-leg purchased online"

Responses to "C-leg purchased online"

Kinsey Herrin

8/26/2014

Dear List,

Thank you for the responses I received to my question regarding our patient
who would like to purchase a C-leg online. The answers are very interesting
and show that practitioners are handling this in many different ways.

I did speak with our rep from Otto Bock today who informed me that all
warranties go with the original patient, therefore any servicing costs
(including the fee to provide an estimate) would be the responsibility of
the patient.

Please see the original question and responses below.

*Original question:*
Dear List,
We would like to know how practitioners are handling patients who purchase
componentry online. We currently have a patient who would like to purchase
a C-leg off of Ebay for $3000.
If you have dealt with this situation, we would be interested in hearing
how you handled it, specifically:
1. Are you billing for the time you spend programming the knee? If so, what
codes are you using?
2. How are you handling servicing of the knee? Is this something Otto Bock
will even allow?

*Responses:*
- I attend an amputee clinic at the local VA hospital. One of the veterans
rejected a c-leg fit by one of my competitors (poor eval skills). The
clinic asked me to fit it on a patient of mine who was a candidate for a
C-leg and who knew what the situation was. He was an established C-leg
wearer and did not mind.
I fit that unit and when it needed service we chucked it and fit a new
C-leg. Everyone was happy.
I billed for my time and we did a socket replacement and foot too.
I personally would fit the C-leg with a disclaimer signed by the patient.
The are many components listed on eBay.

- I would contact Otto bock and ask them about the servicing. If they have
money to purchase online they should have money to give you to program or
whatever.

- I experienced this with a foot. I had them sign a waiver. I also brought
to his attention the inappropriate category of the foot. I got the serial #
off the foot and found out it had a full warranty and had never been
provided to a patient.
I don't think you can bill insurance for the time but I sure would bill the
patient.

- Call and ask Otto bock. We've had a few buy them. I program them at no
cost if I'm providing a socket replacement. Haven't done one without.

- Hourly cash pay only. No other option.

- Absolutely not.

- I would do it for free if they are your patient or you want them as a
future patient. I see no liability if they purchased it and you were not
paid. Servicing is probably if it's not broke don't mess with it.

- We had a patient that made this type of purchase online. Otto Bock
would not service the c-leg as it was not registered to that specific
patient. Adjustments we did were billed to insurance and paid. Hope this
helps. We have only had one of these situations and goes back
about 5 years.

- I believe you would risk a lawsuit since you are using a used component.

- Otto Bock won't allow any servicing to the knee. They can track the knee
to the original patient who it was sold to and crosscheck with what you
send them.

In the past, had a patient brought a knee to me that they purchased from a
non approved O&P type vendor, I have explained to the patient that our
company would offer no warranty to the component and accept no liability
for anything that happens while they use it. All I did was copy the program
from an old C-leg of their's. The reality of the matter is I should never
have touched it.

If you bill for the time to program a knee that technically you shouldn't
be programming, that can be unethical. Keep in mind, if the patient
purchases the knee from an unknown/unverified source and you do ANYTHING
(even simply copying a program or zero setting it) you now take on all the
liability of the knee, the function of the knee for the patient and any
additional problems that might arise. If the knee fails and the patient
falls and gets injured, what defense do you have in court to say that as a
certified prosthetist you could justify that you did everything correctly
and could prove that there was nothing wrong with the knee when it was fit?
(this relates back to my last statement in the paragraph above)

I have also dealt with patients who have left their leg as a donation to
someone who could use it after they died. In this case, Otto Bock checked
the knee for us (if it was still under warranty) and there was a whole lot
of paperwork to make sure the knee got transferred accordingly to the new
patient. It was not sold to anyone and I did not bill for the time to
program it as this was done as a donation.

- Dear Kinsey,
Ottobock does not recommend purchasing a C-leg on Ebay. There is no way of
knowing what condition the knee is in and therefore may likely require a
significant amount of service in order to get it up to our standards and
service requirements. The reason is that as the knee ages, there is
deterioration and we feel there are things that need to be replaced in
order for it to work as intended. At this time the device is also only
intended for a single user. What this means is that there would not be any
extension of a warranty to any new users of the device. If you have any
other questions regarding servicing a C-leg of this nature, please let me
know.
Thanks,
Mark

Mark Edwards, MHPE, CP
Director, Professional and Technical Services
Ottobock

-I have done this a few times in the past, although not real recently. I
simply laid out for the patient up front what he/she could expect,
particularly regarding warranties, and the risk of purchasing a bogus
knee. This included my time, as best it could be estimated without knowing
the actual condition of the knee, and I gave them a short list of the costs
of common service items from the manufacturer. As a practical matter, if
the patient was covered by Medicare, any expenses along this line would
only be covered if the knee was deemed necessary for the patient, whether
or not Medicare had paid for the knee. This will require the same
evaluation by a physician as it would if a knee was being acquired through
Medicare. This situation is begging for an audit generally, so you will
want to have all of your documentation ducks in a row.

Initially, I told them that there was a risk that the knee was not actually
usable, but that this might not be known until the knee was evaluated by
checking it with C-Soft, or until a trial fitting was performed, and if it
did not work, or work properly, then possibly not until after an evaluation
had been done by the manufacturer, and possibly not until repairs had been
done, which were expensive.

My time was billed on an as-needed basis, using code L7520. If the patient
was Medicare, or certain other insurers, I advised them that there was a
limit as to how much of this code could be used in a year, and they would
be responsible for any time required above that limit.

Regarding Otto Bock servicing a knee for other than the patient it was
originally provided for, I do not know what their policy is at this time,
as it has been probably 5 years since I have done this. The last time I
tried this, the knee was technically still under warranty, from a time
standpoint, but they would not extend the warranty to the new user,
although they would service the knee for their usual fees. In one case,
although I can't recall if it was Otto Bock or another manufacturer, they
would not warranty the service needed if the regular interval service had
not been done, which would then add another expense.

Depending on your patient's situation, this can work well. That most
recent one I did was covered by Medicare, and had already been evaluated by
her physician, deemed appropriate for an MCP knee, but having no supplement
she could not manage her 20%, so she did not go forward. She found a C-Leg
at a garage sale for $100, and bought it, and brought it to me. Testing
indicated that it was still functional, and that it had not actually been
used much, although the batteries were tired. She had a relatively new
socket and a good foot that could work with it (acceptable build height),
and the end of the story is that between her purchase price, my time, and
new batteries, she had a great prosthesis for about $1400.
There are other situations, though. Some insurances will not cover any MCP
knees, so if someone has the cash and can get the knee, I would see no
reason not to try, again depending on Otto Bock's current policies, the
patient's risk tolerance, and your appetite for a gig like this.

You have to be somewhat careful, though. Charging for time on an as-needed
basis can make you look like you are nickel-and-diming people, or dragging
the job out, so you have to explain what you are doing, and why, very
carefully. If I did more of these, I would probably develop a special fee
schedule, with different tiers. The lowest would assume a fully functional
knee, with no need for service or special attention, just mounting,
adjusting length, aligning, programming, and some small amount of gait
training. There would probably be a middle ground that would allow more
time for a change of foot or other components, plus the cost of those
components, or for service that is required for the knee, or for additional
gait training, and some higher level yet if all of those things are
required plus perhaps more involved gait training. Short version, some
fixed fees for my time, plus component and service costs. How this would
work with insurance companies other than Medicare might be a challenge to
sort out, and I might find that I would only want to do this on a cash
basis.

One of the cases I had several years ago worked out well with that
insurance company, but that was primarily because I had a good relationship
with a senior claims examiner, and he knew that I wouldn't rip them off.
In that case the patient had coverage for an MCP knee, but again could not
deal financially with their 20% co-pay. The insurance company was happy to
pay a small fraction of the cost of a new one for my time, a new foot, and
an adapter, and since interval service is part of having an MCP knee, they
even paid for that. I don't know how common that would be, or if insurance
is even in the picture in your case.

Hope that this was helpful.

- We do not touch those it’s a just not professional and it may have
negative ethical implications, depending on how knee ended up on ebay.
Good chance if you purchase that knee and send to Otto Bock for service or
maintenance you would get repair cost of thousands who is going to pay
this and how will you justify this to payer who is paying for adjustment on
another patients knee. Its best to avoid this type of business in my
opinion.


--
*Kinsey Herrin, MSPO, CPO/LPO*
Certified/Licensed Prosthetist/Orthotist
Ortho Pro Associates, Inc.
(305) 598-9688