Insurance Denied Her Prosthetic, She Fought to Walk at Graduation
Reading Time: 4 minutes
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Summary:
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College student denied prosthetic coverage ahead of graduation
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Aetna claimed the device was for comfort, not medical necessity
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Family paid $7,500 out of pocket after two denials
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Insurer reversed denial after receiving “more critical information”
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Insurance denials for prostheses are all too common. For many, repeated rejections can lead to giving up. However, Gabrielle Guerrero from Burleson, Texas, decided to fight for her right to walk and find relief from pain.
At 15, an off-roading accident drastically changed her life, resulting in a severe injury to her left foot that required amputation of part of it. Despite the daunting experience, she learned to adapt. At 21, she faced a new obstacle: convincing her health insurance company to cover a replacement prosthetic foot in time for her college graduation last December.
Guerrero relies on a custom prosthesis that relieves pressure on her remaining foot and makes walking more comfortable. After six years, her original device wore out, lost its artificial toenails, and developed tears that compromised stability.
Guerrero’s mother filed a claim with their family’s Aetna health insurance for a new prosthetic foot, but it was denied. The insurer said it was “improperly coded” and claimed the device was not “medically necessary,” but rather for “appearance, comfort, or convenience.” This was heartbreaking for Guerrero, who said in an NBC News interview that the anger she felt brought her to tears. She couldn’t understand how comfort, a basic requirement for walking, could be considered unnecessary.
Anger brought Guerrero to tears. She couldn’t understand how comfort, a basic requirement for walking, could be considered unnecessary.
Guerrero had a deadline: her December 2025 college graduation. She wanted to walk across the stage in a cap and gown, wearing her new, well-fitting prosthetic foot. As time ran out and no resolution was reached, her mother paid $7,500 out of pocket for the prosthetic, charging it to a credit card to ensure timely delivery.
Even as the family moved forward with the payment, NBC News contacted Aetna for comment. After reviewing the case, the insurer reaffirmed its refusal. Guerrero received a second denial just days before graduation, increasing the family’s frustration and raising questions about how insurers handle prosthetic coverage.
After Guerrero’s graduation, the insurer provided updated reasoning. In a follow-up conversation between Aetna and Guerrero’s prosthetist, the insurer explained that the initial claim lacked enough information and the requested prosthesis did not meet the criteria for restoring function or mobility, also noting it might slip off and cause a fall. The prosthetist, however, did not respond to NBC News’ requests for comments on this discussion.
Despite the setbacks, a higher-level review eventually led to a significant change. Aetna reversed its decision and agreed to cover the prosthetic after receiving “more critical information” than in the original submission. This reversal enabled Guerrero’s family to be reimbursed for the cost—a rare but welcomed outcome.
Guerrero’s story highlights a common issue faced by many relying on prostheses: insurance denials are frequent. Advocates say these refusals aren’t unusual and are expected among many patients who need prosthetic devices. Nicole Ver Kuilen, director of impact campaigns for the Amputee Coalition, told NBC News that the amputee community faces a prolific number of denials, and it is not a matter of “if you’ll be denied, but when.”
The amputee community faces a prolific number of denials, and it is not a matter of “if you’ll be denied, but when.”
Coverage can vary greatly by state and plan, and even when devices are deemed medically necessary, insurers may interpret policies narrowly or demand extensive documentation for approval.
Industry experts share this concern. Gerald Stark, president of the American Academy of Orthotists and Prosthetists, noted that nearly all patients he encounters have experienced some form of denial at least once. These setbacks can be discouraging for those already overcoming daily struggles due to limb loss, prompting many to repeatedly appeal or find alternative funding sources.
For Guerrero, the ordeal went beyond finances—it was ultimately about dignity, independence, and full participation in life. During her graduation last month, she stood proudly in her cap and gown, with her new prosthetic foot properly fitted and functioning. As she walked across the graduation stage, the picture presented a powerful symbol of triumph in a difficult battle that many others may relate to.
Related Reading:
Medicare and Prosthetic Limbs: Coverage for Amputees Explained
The Battle for Mobility: Insurance Denials and Prosthetic Access
How to Afford a Prosthetic Limb: Grants, Programs, and Funding Resources for Amputees
