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Erie woman fights to get new artificial legs [Erie Times-News, Pa.]

The prosthetic legs enable the 52- year-old Erie woman to get out of her motorized wheelchair and stand on her own. The only problem was that her health insurer, Highmark Blue Cross Blue Shield, told D'Aurora it wouldn't pay for them. Twice, Highmark said the new legs weren't a "medical necessity" before finally approving them a week ago, just before Christmas.

By David Bruce, Erie Times-News, Pa.
McClatchy-Tribune Information Services

Dec. 29--A pair of artificial legs stands against a wall in Susie D'Aurora's eat-in kitchen.

They are a source of pride and pain for D'Aurora, whose own legs were amputated below the knees earlier this year.

The prosthetic legs enable the 52-year-old Erie woman to get out of her motorized wheelchair and stand on her own. The mobility comes at a cost, however.

"I can walk in these, but they make my hips and lower back really start to hurt," D'Aurora said. "I can last about an hour if I'm moving, less if I'm just standing around."

D'Aurora's physician and two others have recommended a new set of legs with microprocessor-controlled ankles and feet. They would enable D'Aurora to stand more easily and walk with less effort.

The only problem was that her health insurer, Highmark Blue Cross Blue Shield, told D'Aurora it wouldn't pay for them. Twice, Highmark said the new legs weren't a "medical necessity" before finally approving them a week ago, just before Christmas.

D'Aurora worked as a teaching assistant in the Erie School District and often went jogging or took dance classes in her spare time.

In June 2011, she developed flu-like symptoms that worsened into a life-threatening bloodstream infection. She went into cardiac arrest and wound up spending more than six months at various Erie hospitals recovering from the infection and subsequent amputations.

Eighteen months later, D'Aurora undergoes intense, 90-minute physical therapy sessions twice a week in an effort to use her body to the best of her ability.

"I am a young, relatively active person -- at least I was," D'Aurora said. "I don't want to spend the rest of my life in a wheelchair."

D'Aurora tried a pair of artificial legs with microprocessors a few weeks ago and loved how they felt.

"I tried two different types of legs for about an hour each," D'Aurora said. "Instead of feeling sore afterward, it was like they gave me more energy."

That's because a microprocessor-controlled artificial leg enables the foot to move up or down depending on the terrain, said Kelly Kopkowski, D.O., the Saint Vincent Health Center physician who oversees D'Aurora's rehabilitation and recovery.

"These ankles can sense the difference in terrain," Kopkowski said. "If you're walking downhill, they will compensate. If you're walking on gravel, they will compensate."

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They can even help D'Aurora stand for extended periods with less hip and lower-back pain, said Steve Burke, her physical therapist at Millcreek Community Hospital Outpatient Therapy.

"People with a static foot tend to fall backward a little when standing, so they compensate with their hips and pelvis," Burke said. "That adds to the soreness."

Not surprisingly, microprocessor-controlled artificial legs are more expensive than traditional ones.

They cost about $33,000 each, D'Aurora said, about twice the cost of the ones Highmark initially covered.

"I can tell you the artificial legs with microprocessors are never approved the first time," Kopkowski said. "It's not just Highmark. I deal with other insurers, and it's the same story. It's letters, it's phone calls. It's a fight."

A Highmark spokesman said the company's policy doesn't cover artificial legs with microprocessor-controlled ankle/foot prosthesis.

They are considered investigational, the spokesman said. There is a lack of studies demonstrating the clinical benefit of the microprocessor-controlled ankle/foot prosthesis over the conventional prosthesis.

But a few days after talking with the Erie Times-News, Highmark reversed its decision. It sent a fax to Kopkowski's office Dec. 21 approving the legs.

Kopkowski officially notified D'Aurora about the reversal Thursday during a visit to the Saint Vincent physician's office.

"It's too bad I had to struggle a little through this ... but it's still a gift," D'Aurora said. "Once I get them and use them, they will seem real."

It will take a month, maybe longer for D'Aurora to get fitted for her new legs and have them available to use, Kopkowski said.

Kopkowski expects the new legs will be more stable for D'Aurora and should reduce her back and hip pain.

"They are going to make a significant difference for her," Kopkowski said. "Ten years from now, instead of sitting in a wheelchair and not being able to move, she could be going out to movies and dinner, living her life."

DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him on Twitter at twitter.com/ETNbruce.

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(c)2012 the Erie Times-News (Erie, Pa.)

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Visit the Erie Times-News (Erie, Pa.) at www.GoErie.com

Distributed by MCT Information Services

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