Investigations

Knoxville man fights insurance company for new prosthetic arm

KNOXVILLE, Tenn. (WATE) - A Knoxville man wants a new prosthetic arm. Tommy Jones lost his right arm in a farm accident at age 17, but he's worked ever since. His insurance company said he didn't need the prosthetic arm, saying at first the high tech arm was not medically necessary.

The information Jones received in February from Blue Cross Blue Shield of Tennessee hit him hard emotionally. He said he desperately needs a new arm and has never asked for anything before.

For about 35 years, Jones has been a heavy equipment operator. Jones lost his right arm nearly 40 year ago in a farm accident, but he uses his left arm with ease. Jones has never been on disability and rarely missed a day of work, until last year when his left arm gave him trouble. 

"I fell a year ago and tore a tendon. They had to go in an attach it back," said Jones. "I was out of work, like two months."

Earlier this year, his therapist suggested that Jones have his left arm tested. A strength test showed it was in bad shape.

"I'm worried. I can't live depending on somebody to take care of me. It's hard. I can't hold my grand babies... great grandchildren because I'm afraid I'll drop them because at times my arm gives out and it just goes," he said.

In February, Jones was given hope. At Victory Prosthetics in Knoxville, a certified prosthetist tested a high tech prosthesis. The discovery was that muscles in Jones's shoulder were alive. He could willingly move and control the hand and fingers in what will be an upper limb prosthesis.  His insurance company, however, denied the limb.

"The insurance turned it down. Said, more or less, the way I understand it, I don't need it," said Jones.

Jones says he needs his good arm to work. He says the new prosthesis would make his life whole again.

"If I don't get it and I have to keep working, I'm going to end up losing this arm, " said Jones, fighting back tears. "I have worked, I have never asked for help, never."

Two weeks ago, WATE 6 On Your Side wrote to Blue Cross Blue Shield of Tennessee, Jones's carrier. We told them about him, how his use of the high tech hand was successful, according to his therapist. 

Within days, Blue Cross Blue Shield of Tennessee replied saying they had approved the prosthesis. The company said "initially the requested prosthesis fell into an investigational category" because "the finger articulation capabilities are new. Our responsibility is to advocate for affordability and safety."

"Any time new technologies are introduced, we review scientific literature to see what effective options exist to meet each members' needs. We have completed our review, we have approved the prosthesis," they went on to say.

Jones said his prosthetist called with the good news.

"I've been on cloud nine ever since. I'm anxious to get it started," he said.

Victory Prosthesis says it will be several weeks before they're ready for Jones's fitting. Then it will take a few more weeks of testing and therapy before he's ready to go to work with his new arm.


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