Amputees face complicated system getting help paying for artificial limbs

A Pointe-du-Chne man who lost his leg in a motorcycle accident in 1997 uses a prosthetic leg so worn out that parts of it are wrapped in duct tape.

Marc Polley says he can't afford a new leg thatwould allow him to teach yoga and do other activities, and New Brunswick doesn't cover anything more than a basic model.

Polleytold Radio-Canada that he may move to Nova Scotia, where he believes the coverage is better.

But others in the system disagree, saying that navigating the labyrinth of funding in New Brunswick is difficult butcomparable, if not better, than other provinces.

Kirsten Simonsen, a prosthetist at Eastern Prosthetic Clinic in Moncton who has workedin the field for 28 years, lost part of her foot as a child. She said she is familiar with accessing prosthetics in different provinces.

At Simonsen's clinic, she and her staff determine what will best suit a patient's needs based on a variety of factors such as age, health, level of activity and cost.

The prosthetic is built on site at a shop in the back. Once the mechanical limb is place, patients are taught how to use it, then return to the clinic for followup and adjustments as needed.

Simonsensaid any prosthesis is expensive, and her clinic ensures every patient has one that fits and works properly.

A patient in New Brunswick receiving aprosthesisthrough the Social Development Department gets the equivalent of what any person accessing a publicly funded system in the country would get.

There is no such thing as a "welfare" leg, Simonsensaid.

But there are people who slip through the cracks.

Sydonyia Crossman of Little Lepreau was born with spina bifida and doesn't receive any provincial funding for her prosthetic.

"My right foot was turned out and twisted, so when I was a year and a half I had to do some corrective surgery, and I lost my foot and part of my ankle to that surgery."

She was fitted with a boot-type prosthesis and sent home. But she said thanks to her parents' commitment, she was walking again by the age of two.

Later, because of health problems she had another amputation, this one below the knee.

It's easier physically, because you don't have to think all the time where you are because the leg thinks for you.- Clarence Allain

Her last prosthetic leg lasted 14 years, but in December, she replaced it with one that cost more than $9,000.

Crossman said many people assume prostheses are paid for by the province, but that's not a given. In New Brunswick prostheses fall under Social Development, which requires patients to prove a financial need.

Because Crossman has a life insurance policy, considered an asset by the department, she doesn't qualify for provincial money.

She turned to War Amps, whichpaid $4,000, to her husband's insurance, which covered $2,400 and to her church, which raised the rest.

Crossman is grateful for the much needed help but worries about others who may not be so lucky.

"The issue is that if our church had not taken up an offering, we would have been responsible for thousands of dollars out of pocket," she said.

"It's a lot of money."

A government spokesperson said the department couldn't speak about specific cases but it has not refused a prosthesis deemed medically necessary in the past 12 months.

Social Development bought 25 prostheses for the year 2017-2018 and 13 in 2018-2019. None of the "basic model" claims by patients exceeded the maximum of $20,000.

Few can pay on their own

Simonsen's clinic specializes in trauma, so other clinics may have different numbers, she said, but workers' compensation covers a quarter of her patients and Social Development covers 15 to 20 per cent.

"I ran some numbers and it looks like somewhere between three to five per cent of patients are paying out of pocket."

Some of those people, however,have received money from lawsuits to cover expenses such as prostheses, she said.

A claim often involves one of many insurance companies, each with itsown policies, War Amps, and the Department of Social Development, which requires a patient to prove a financial need.

Simonsen said the RCMP, Correctional Services Canada and the Canadian Armed Forces all have their own departments for dealing with claims.

"It takes a NASA engineer to navigate some of it."

Two people at her clinic work full time to help people get through these complicated systems.

And money can make a difference, Simonsen said.

For example, Serge Morneau of Saint-Isidore lost his leg in a snowmobile accident when he was six.

Because he was a child, War Amps stepped in and covered all the costs and continues to do so.

Morneau is thankful to have his prosthetic, a crucial tool in his life, and he walks with only a slight limp. But his mechanical leg makes it difficult to walk in crowds or in the dark.

He takes stairs one by one, and there is no walking backwards. He said he's always concerned aboutfalling.

$100,000 forleg with computer

If there were any way to pay for it, Morneau would opt for a much more expensive "robotic leg."

These more expensive prosthetics, called microprocessors, can cost more than $100,000. The leg comes with a computer and sensors, and it needs recharging.

Morneau had the opportunity to try one once, and he's wanted one ever since.

"You walk way better with that."

He said he'd take a personal loan out if he thought he could afford it.

Clarence Allain knows first-hand that microprocessors make walking, and life in general, much easier.

Allain lost his leg in 2003, when he was T-boned while driving his motorcycle. Allainlearned to walk again in about three months, starting with a mechanical leg.

"It was a more simple leg, just like a piston and that was it," he said."When you were walking you had to concentrate all the time."

But his insurance policy through his employer covered prosthetics, so he upgraded to a micro-processor model.

"It's easier physically, because you don't have to think all the time where you are because the leg thinks for you.

"You can turn on a dime if you have to."

Allows him to work

Allain won't say how much money he paid out of pocket, but 80 per centwas covered by insurance.

"This one here, I paid quite a bit,"he said.

But mentally and physically he's better off with his pricey prosthetic. He doesn't think he'd still be able to work with a mechanical version.

Both Morneau and Allain would like to see microprocessors available to more people and wonder if it would cost the province less in health care in the long run.