The Fight for Prosthetic Parity Heats Up in Missouri and Across the Nation

Do working Americans who pay for health insurance deserve to walk again and return to work if a medical condition lands them with limb loss?

That’s the question before twenty-three state legislatures across the country. Parity laws require health insurance companies to cover prosthetic limbs when deemed medically necessary by a physician, without setting unrealistic price caps or once-in-a-lifetime clauses. When insurers fulfill their obligations, amputees are much less likely to depend on government services like Medicaid.

Medicare, Medicaid, and the Department of Veteran Affairs already provide the coverage required by parity laws. But a movement to cut healthcare costs has led some private insurers here in Missouri to place annual limits on prosthetic coverage, ranging from $1500 to $4000, not quite half the cost of a below-knee prosthesis.

Insurance companies and government payers have always used provider contracts with companies like P&O Care to dictate how much they will pay for different types of prosthetics. But these new caps are imposed directly on patients, regardless of their different needs. Individuals and employers shopping for health coverage should not be expected to know that $1500 is an unreasonable cap on prosthetic coverage. In essence, these insurers are advertising that they cover prosthetics, but when patients need that coverage, it isn’t actually paid for.

One of P&O Care’s own patients, orthopedic surgeon Dr. Matthew Bradley (picture above), has testified before the Oregon State Legislature on behalf of a parity law that seems likely to pass there this year. Now, Matt has plans to use his expertise to help work for parity legislation here in Missouri. Through a new committee, P&O Care is joining with individual citizens, prosthetic providers, and advocacy groups all over the Show Me State to get a parity law passed here in 2008.

Besides Oregon, six other states have already passed prosthetic parity laws, including Colorado Maine, New Hamshire, Rhode Island, California, and Massachusetts, where former Governor Mitt Romney was a key supporter. Missouri Governor Matt Blunt has announced that he is supporting Romney’s bid for President: Does that mean he might support prosthetic parity, too?

Jennifer Burget, ABC Certified Orthotist

Before she became an orthotist in 2003, Jennifer Burget, CO, worked as an athletic trainer for SLU’s men’s soccer and basketball teams, as well as Washington University’s football team. After graduating from the physical therapy program at SLU, she worked as the Director of Orthopedics for a local DME company.

To gain more practical experience, Burget moved to Beverly Hills, California to work under one of the best, most well-respected orthotists in the field, Max Lerman of Lerman and Son. In California, Burget was one of two orthotists serving the highly respected Cedars Sinai Hospital.

After gaining priceless experience in Beverly Hills, Jennifer was ready to return to the Midwest. When she met with Jim Weber, CEO of P&O Care, Burget knew she had found the perfect fit. “Since moving to St. Louis, I have joined an amazing team of practitioners,” she says. Jennifer is dedicated to helping others and always strives for a perfect fit.

Kerth Langeneckert: Trucker, Harley Enthusiast, Amputee

Kerth Langeneckert drives a truck for a living and still loves to ride his Harley Davidson, but in 2005, he was involved in a motorcycle accident that left his left leg badly broken. After surgery, he developed an infection and eventually had to undergo an above-the-knee amputation. He describes himself as “being in a state of depression” after he lost his leg. After his prosthetist Dan Luitjohan made him a new leg, Kerth said, “It’s just good to finally get up out of a wheelchair or crutches and stand on two legs and actually walk on my own.”

Langeneckert’s insurance at the time of his amputation paid for his first prosthesis. His new leg even enabled him to go back to work driving a truck with a manual clutch. After two years, however, his residual limb has shrunk, causing the socket of his prosthesis, the part that fits over his leg, no longer to fit properly. A poorly fitting prosthesis is very painful and can sometimes lead to blisters, infection, and sometimes new amputations or death. Prosthetic limbs do show wear and most amputees experience some change in the size of their residual limbs and require new sockets from time to time. And a new prosthesis may be required, sometimes every 3 to 5 years.

The private insurance Kerth has with this new job won’t pay for him to get a socket replacement so his leg will fit. How was his employer, a trucking company, supposed to know that $2500 is an unreasonable cap on annual prosthetic coverage? Parity legislation (see cover story) is needed in Missouri so working amputees like Kerth Langeneckert can continue to live with the quality of life they deserve.

Dan Luitjohan: ABC Certified Prosthetist, Family Man

In August 2006, P&O Care was excited to strengthen its prosthetic team with the addition of Dan Luitjohan, CP. In addition to caring for amputees who have lost legs to diabetes or peripheral vascular disease, Dan takes a special interest in pediatric and upper-extremity (arm) prosthetics. He has also introduced our team to a new design for above-the-knee prosthetics called the Marlo Anatomical Socket. This socket design allows for greater range of motion, is less visible through tight clothing, and provides a more comfortable fit, especially for high AKs with shorter residual limbs.

Luitjohan became a Certified and Illinois Licensed Prosthetist in 2001 after completing the prosthetic program at Northwestern Medical School in Chicago and a residency in St. Louis. Dan and his wife Julie live in Edwardsville, IL, and have two young boys. When he isn’t changing his patients’ lives, he can be found chowing down at Fast Eddies in Alton, hiking the bluffs of southern Illinois wine country, and spending time with his family.

Letter to the Editor

The Following Letter to Editor has appeared in the St. Louis Post-Dispatch and the Kansas City Star:

My husband, Ivan, is the bravest and most determined man I know. He was in a near-fatal accident almost two years ago. After several surgeries to save his right leg, it was amputated below the knee. A titanium rod replaced his femur above the knee.

Ivan works in construction. His employer saved his job for him for the seven months it took him to rehabilitate himself. He wears a below-the-knee prosthetic.

He worked hard to be able to go back to work and do the same job he has always done — and he succeeded! But now our future is unclear.

In return for premiums paid for health insurance, we consumers expect to be covered for catastrophic injury or illness. Sadly, without legislation to ensure coverage, many private health insurance providers (including our own) have decided to severely limit or completely deny coverage for prosthetic limbs.

Arms and legs are not a luxury! They are a necessity to lead a productive life. I have contacted my legislators to try to push for a bill to ensure prosthetic coverage without unreasonable limitations. I urge others to do the same. Hard-working people deserve the right to be able to work to support themselves and their families.

Teri Burgener, Republic, Mo.

Nationwide, Current Restrictions to Prosthetic Coverage by Private Insurers Include:

• No coverage for repairs or replacements
• Increased co-pays, deductibles and out-of-pocket expenses
• A cap on benefits if a patient receives a prosthesis from another insurance company
• Annual caps of $1000 to $5000
• $2500 to $7000 maximum lifetime cap
• One prosthesis per lifetime

(This information comes from Action Plan for People with Limb Loss, a publication of The Amputee Coalition of America)