Tuesday, April 15, 2008

Amputee Coalition of America Calls for Prosthetic Parity

From O&P Business News, Online Exclusive
April 15, 2008

In the face of drastically reduced health insurance coverage for prosthetic care, the Amputee Coalition of America (ACA), a national non-profit educational and advocacy organization representing amputees, is calling for federal legislation requiring health insurance companies to cover prosthetic care on par with other essential medical care.

A bill creating the Prosthetic Parity Act, HR 5615, has been introduced in the House. The bill was authored by Rep. Robert Andrews (D-NJ), with Reps. George Miller (D-CA), Todd Platts (R-PA), Mario Diaz-Balart (R-FL), and Lincoln Diaz-Balart (R-FL) signing on as original co-sponsors.

“The introduction in the House of Representatives of the Prosthetic Parity Act is a tremendous positive development. Many of the two million amputees in the United States are deprived of meaningful coverage for prosthetic care by their health insurers, which potentially places a greater burden on society. This proposed legislation would require health insurers to cover prosthetic care on par with their coverage of other essential medical care,” said Paddy Rossbach, president and chief executive officer of the ACA.

“Increasingly we’ve seen health insurers drastically limit coverage for prosthetic care by imposing unrealistically low dollar caps and restrictions, even limiting coverage to one prosthesis per lifetime,” Rossbach added. “Federal legislation is needed to close the insurance coverage gap.”

There are an estimated two million individuals living with limb differences or loss in the United States, including 70,000 under the age of 18.

According to a recent poll by the ACA, among respondents with private health insurance, 24% had experienced a reduction in prosthetic coverage over the past three years. Four percent had their coverage eliminated entirely.

“For less than 25 cents per month in health insurance premiums, amputees will get the care they need to get back to work and live independent, productive lives. The cost to the health care system if this is not done far exceeds that of providing prosthetic care, and places a huge burden on society,” Rossbach concluded.

Thursday, April 3, 2008

Prosthetic Parity Hearings a Huge Success!

Members of the Limb Loss Coalition and amputees from across the great state of Missouri showed up in Jefferson City Tuesday to support the Prosthetic Parity Bill before House and Senate Committees. Representing P&O Care were Jon Wilson, Clinical Director, Mark Woodson, Director of Fabrication, Bill McLellan, Director of Sales, and Suzi Schumacher, a young working amputee and active member of the Coalition.


Around 2:00 p.m., four witnesses testified before the Senate Small Business and Insurance Committee, chaired by Senator Lowden. Dr. John Rush, Medical Director for Hanger Orthopedic and a national expert on prosthetic parity, flew in to testify on many of the more technical issues. Then Mark Wilson, President of Prosthetic and Orthotic Design, Inc., in St. Louis testified that as a small business owner, he was not given the option of purchasing health insurance that did not include ridiculously low caps on prosthetic coverage. Next, Jeff Damerral, Chairman of the Missouri Coalition for People with Limb Loss, testified about his personal experience loosing both his legs below the knee to meningitis while a freshman at Truman State University. Damerral said that while he had good insurance through his father at the time, he is fighting for everyone who doesn't. Now that he is on his own and working as a lawyer for a small firm, Damerral must pay approximately $16,000 every 3-5 years to have his two legs replaced.

Finally, AK amputee and Secretary of the Coalition Jean Freeman brought the whole room to the verge of tears, telling how caps on her prosthetic coverage force her to hope that the various parts of her prosthesis don't wear out at once. "As an amputee, I am being discriminated against," she said.

Several registered lobbyists for the insurance companies spoke briefly against the bill, saying they opposed prosthetic parity for the same reason they have always opposed every other "mandate" the state has passed, such as those insuring coverage for mental health, women's health screenings, and wigs for children with cancer. They believe on principle that policies should be able to exclude coverage for any condition, provided that policy can be sold to a customer or employer. On being questioned by Senator Day, one gentleman did not know that some plans include once-in-a-lifetime clauses for prosthetic devices. "Do you mean that a person is expected to wear the same leg at 18 months as 18 years?" she asked incredulously. "I'll have to get back to you with that information," he replied.


The hearing in the House of Representatives began around 7:00 p.m., and since it was after business hours, many more supporters showed up. The bill sponsor, Rep. Dr. Wayne Cooper, introduced it to the committee, and Dr. Rush, Jeff, and Jean testified again. This time Jon Wilson, Clinical Director of Prosthetic and Orthotic Care, Inc., represented the state's prosthetists. "Surgeons often ask me to speak with patients before they loose their limbs, often to convince them that it's worth an amputation to save their life. I tell them I can help them walk again," Wilson said. "But later, when they're ready for the prosthesis, I have to be the one to tell them that their insurance won't pay for it. When they need health insurance the most, it isn't there."

Wrapping things up was Bill Brannan. He told how good health insurance has enabled him to live a productive life for ten years since he lost his leg at age 65; but he also told about meeting a young mother in a grocery store, juggling her kids and her cart and trying to get along in a wheelchair because her husband's insurance would not pay for her to get a prosthesis. The fine individuals who had to get up and represent the insurance companies after Bill sat down seemed like they were just going through the motions, stating rather plainly that they always oppose mandates, even inexpensive ones that seem to make all the sense in the world like ours does.

The representatives seemed to understand our case, and members from both parties told us the hearing had gone extremely well. It's always dangerous to get over confident, but here is what Dr. Rush thought comparing the parity effort in Missouri with other states where he has testified: he said that whereas elsewhere most of the real work gets done behind the scenes and hearings are just window dressing, we could have actually won our case in one day on hearings alone! We'll wait and see just where things go from here.