New Robotic Leg Helps Patrick Get Back to Walking

Four years after Patrick Silvestri, 66, lost his leg to gangrene and amputation above the knee, he finally received what he so desperately needed and had wanted — a new leg! During those 4 years, even with the help of his doctors, Patrick was unable to obtain a prosthetic leg that fit well and an electric wheelchair that could withstand the rugged terrain where he lives in rural Florida.

This all changed after Patrick decided to look for a new Medicare Advantage plan. He called Humana and was connected to Darlen Mangano, a telephonic licensed Humana sales agent. Patrick was ready to make a change. Darlen carefully explained Patrick’s insurance options as he qualified for a Humana Medicare Advantage Dual Eligible Special Needs Plan (D-SNP).

Dual Eligible Special Needs Plans (D-SNP) are Medicare Advantage plans uniquely designed for people who are eligible for both Medicare (a federal program and Medicaid (a state program). These plans help to coordinate care and benefits between Medicare and Medicaid. Plan coverage may vary by state.

Generally, persons receiving Supplemental Security Income (SSI) disability, like Patrick, are eligible for Medicaid—state-run programs that help to pay medical costs for certain groups of people with limited income and resources. When you’re also enrolled in a D-SNP plan, total out-of-pocket costs you pay for covered services may be less because of additional support from federal and state government programs.

Personal Attention
Darlen became Patrick’s assigned licensed sales agent and point of contact. Patrick had signed up for insurance at the tail end of a month and Darlen called him only days later at the beginning of the next month to confirm that Patrick’s new coverage was active and ready to be put to the test.

“Darlen called me and asked, ‘What do you need? What is it that we can help you with?’” said Patrick. “I need a leg so I can start to walk again, but I also need some kind of electric wheelchair because I live in an area that has a lot of sand. I’ve broken six wheelchairs already trying to get around.”

Patrick had been receiving donated wheelchairs from his local church, but they weren’t suited to his needs. Twenty-five days after signing up for his Humana plan, receiving prescriptions from his doctors and submitting prior authorization requests, Patrick received a call that a new advanced electric wheelchair was being custom-built for him. A month later, Patrick was also informed that he’d been approved for a new leg.

In less than two months, Patrick received confirmation that Humana not only listened closely to what he needed to live a better life but made sure that he would get what he needed as quickly as possible. Humana was putting Patrick’s health first.

Custom power wheelchairs are costly and take time to be made, often six months if there are no delays. Patrick received his chair approximately six months after it was approved. Robotic prosthetics are also complicated machinery and take time to manufacture and customize to the individual. It took several months and many adjustments to get Patrick exactly the leg that he needed.

Determination
Patrick hasn’t had an easy life, but his ingenuity, vision of an engineer and skills of a machinist have kept him independent. Twenty years ago, Patrick fell from a box truck, broke his femur and shattered his pelvis, requiring a partial hip replacement and causing temporary paralysis. He was told he would never walk again. But Patrick didn’t let this stop him from getting around. He modified his truck so that he could control the gas pedal with his hands. He even modified the engine to improve gas mileage while he was at it.

Four years ago, when Patrick developed gangrene in his foot following an accident and subsequent infection, he required surgery to remove the infection. Patrick underwent several operations which ultimately led to Patrick’s leg being amputated above the knee. A complication occurred during one of the operations and Patrick lost the use of his left hand. Again, that didn’t stop him; he outfitted his truck with a steering wheel ball so that he could continue to drive.

Although Patrick can use his skills to repair almost anything—such as jewelry, watches, electronics, refrigerators, sewing machines, automobiles and more — his income is limited, and he lives in his truck and a tractor trailer container. Patrick has Medicare and receives supplemental security income (SSI) from the government and he is eligible to enroll in the Humana Medicare Advantage D-SNP plan. It fits his health needs and is affordable for him.

Compassion
Once Patrick signed up with Humana, we got to work addressing some of the social determinants of health that impact his quality of life: food insecurity, social isolation and homelessness. Prior to seeking new insurance, Patrick had attempted suicide and was feeling rock bottom from his struggles just trying to get the medical attention and durable medical equipment he required.

Humana connected Patrick to services that offer members access to virtual doctor visits for urgent care and mental health care. Patrick is particularly impressed with the counseling services he receives.

“I get counselors who call me to make sure I’m okay, and ask if I need anything,” said Patrick. “That's something about your service. You guys call me a lot, and I love it. It shows you have compassion, and you care. And when you care, it makes me feel really good that somebody's thinking about me and helping me because I have nobody here. I'm just by myself.”

“My counselor is so enthused. She calls me, asks questions and we talk. It's great to know that somebody cares and I'm really feeling a lot better now. I have no thoughts of suicide anymore because I know that somebody is gonna stick up for me. And they're gonna say, ‘We're right here behind you, Patrick. Whatever you need, we'll help you.’ And that's it. That's Humana.”

Food assistance
With Patrick’s D-SNP health plan, he receives the Healthy Options Allowance that can be used to buy for eligible items like healthy food and other qualified expenses at participating locations. The allowance amounts vary by plan and location.

“Humana sends me food benefits so I can get my groceries,” said Patrick. “Anything I need, the hospital usually gives me. Or someone calls me and says, ‘You’re out of this medication, so we’re sending the prescription to the pharmacy.’ My food is from Humana. And my medical bills are paid—from doctor bills and prescriptions—through my health insurance.”

Each person’s cost of living expenses (such as food or utilities) and healthcare needs and expenses are unique. Patrick’s description of his experience may not reflect your own experience.

Patience and persistence
For Patrick, the new battery-powered robotic prosthetic leg and the power wheelchair are just the beginning. Patrick will need to learn how to use this advanced technology.

“A lot of people, even my doctor, said, ‘You’re going to need to have a good wheelchair because you’re not going to walk right away on your new leg, even though you can balance well now. You’re going to have to learn how to walk again.”

Patrick’s medical team has also encouraged him to use the power wheelchair to get around, but to wear his prosthetic leg even when he’s not walking on it. They also encouraged him to get up occasionally, take a few steps and return to the chair.

“That’s how it’s going to work for a while until I can learn to balance just right without falling down,” Patrick said.

Gratitude
Patrick was filled with such gratitude and appreciation that he put his words in writing and sent a letter.

“Humana is #1 in my mind. A true in – sure – ance company. This is a company that makes sure you get what is necessary. I get answers 24 hours after asking, not 3 months later. Everyone at Humana does their best to help me and not let me down. Ms. Mangano called me repeatedly to let me know what was being done. This was the first time I got good news (finally). Then I started getting phone calls from other agents to see if I needed other things like prescriptions, food, nursing care, etc. This is so great that they call. I feel like everyone cares!!!”

Once Patrick received his new robotic prosthetic leg, he was excited to get back on his feet and get to walking again — one step at a time.

Humana health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, call or write your Humana insurance agent or the company.

Allowance amounts cannot be combined with other benefit allowances. Limitations and restrictions may apply.

Your results may vary. It may not be typical to improve health conditions by taking the actions Patrick did.

Limitations on telehealth services, also referred to as virtual visits or telemedicine, vary by state. These services are not a substitute for emergency care and are not intended to replace your primary care provider or other providers in your network. Any descriptions of when to use telehealth services are for informational purposes only and should not be construed as medical advice. Please refer to your evidence of coverage for additional details on what your plan may cover or other rules that may apply.