Here's a great article on the push for prosthetic parity in Virginia.
http://www.roanoke.com/business/wb/wb/xp-132817
In Missouri, by contrast with Virginia, the effort to get a prosthetic parity law on the books is being led by a committee of amputees, rather than a prosthetic company like P&O Care. The Missouri Coalition for People with Limb Loss will, of course, eventually raise money from prosthetic companies to hire a lobbiest, and it's only right that we help. But patients who have been denied coverage by their insurance companies are leading the push here.
We would also take issue with the characterization of prosthetic parity as a traditional "mandate." Limb loss is a tragic, sudden (even when caused by diabetes) medical condition, the kind of thing that health insurance exists to cover. No one will cut their limb off to benefit from "mandated" prosthetic coverage. We will simply see more amputees going back to work and fewer depending on Medicaid for their prosthetic coverage. Less than ten years ago, insurance policies used to all cover prosthetics on their own. Why not now?
Friday, September 21, 2007
Virginia Parity Push
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By Christina Rogers
981-3264
Josh Meltzer | The Roanoke Times
Several dozen people who use prothetics line up to board a bus bound for Richmond early on Thursday morning as part of a rally to show support for the passage of a state bill that would help amputees get more money from insurance companies than is currently allotted to help cover the high costs of prosthetic devices.
A local company, Virginia Prosthetics, took its fight for better limb-loss insurance coverage to Richmond on Thursday with a bus load of supporters, including amputees, willing to testify before state legislators.
The aim of the one-day trip, which started at the company's Williamson Road location, was to drum up support for a bill that would mandate higher payouts for artificial limbs and force private insurers to match the benefits already offered by Medicare, the nation's federal program for insuring seniors and people with disabilities.
Sponsored by Sen. Patsy Ticer, D-Alexandria, the proposed legislation went Thursday before a special advisory commission that reviews health-related legislation. The commission is a gatekeeper of sorts, deciding whether the bill dies or moves forward for consideration by the 2008 General Assembly.
The commission is scheduled to vote on the bill in November.
At Thursday's hearing, the commission listened to about three hours of testimony from 34 speakers, including representatives of three prosthetic companies. Doug Call, president of Virginia Prosthetics, spoke at the hearing, along with 13-year-old Pete Tainer, of Botetourt County, who has two artificial legs.
The Virginia Association of Health Plans, a Richmond advocacy group for managed health care companies, spoke against the bill. Doug Gray, the association's executive director, said all health insurers in Virginia offer plans that include good coverage for prosthetics. Mandating coverage would push up premiums for employers, he said.
This isn't the first time advocates have pushed to mandate coverage. In 2003, a similar bill was tabled by the same advisory commission because of a lack of public support, said Morgan Sheets, a lobbyist with Knoxville, Tenn.-based Amputee Coalition for America, who spoke at the commission hearing.
That's why advocates such as Call are now raising the volume of their rallying cry and heading straight to the decision-making source.
"We have a lot of need, but it's a very small voice," Call said of the amputee community. "What we're trying to do is step up to the plate and be heard."
About 50 Roanoke-area supporters boarded the bus for Richmond, and they included dozens of amputees who spoke openly that morning about their struggles with insurers. The trip was paid for by Virginia Prosthetics.
While he freely admits his company does have a business stake in getting the bill passed -- mainly, it would require higher insurance payouts for better devices -- he said financial gains are by far not the only motivator.
"What we are charged to do is provide the most adequate care," he said, adding that it's troubling to see those efforts compromised when health care companies put unrealistic caps on what his patients can receive.
In fact, an ill-fitting prosthetic or one in need of replacement could lead to adverse side effects, said Dr. James Chandler, an orthopedic surgeon in Roanoke who specializes in foot and ankle problems. "If they don't have good quality, they're in risk of having an amputation on the other leg."
Still, the past seven years have brought notable cutbacks from private insurers -- so much that some companies have dropped prosthetics from their policies, Call said.
Artificial limbs are also being lumped in with other medical durable goods such as wheelchairs and crutches, causing insurers to low-ball the cost of needed coverage. Call said he has encountered policies with yearly caps of $500 for limb-loss devices. He has even seen insurers limit customers to one prosthetic per lifetime, a move that he said "makes no sense" because any device will need maintenance and occasional replacement.
The average below-the-knee appendage may cost anywhere from $5,000 to $8,000 new, Call said, and that doesn't include maintenance. Such cases of limb loss account for about 80 percent of all amputations, he added, but above-the-knee cases are also common and full-leg prosthetics can run from $10,000 to $20,000 each. One study estimated Virginia has 37,000 to 51,000 people who have lost an eye or a limb.
But they're not the only ones paying for the cost of their care, say reform advocates. Taxpayers also shell out extra dollars, they say, because some privately insured amputees switch over to the more generous government program when their requests for prosthetic care are denied.
"The insurance companies reap the premiums but shift the cost to the state," Sheets said.
The bill seeks to raise private insurers' level of limb-loss coverage to equal that of Medicare. Those benefits include a 20 percent cap on co-payments for prosthetics and coverage of computerized devices. It also sets a minimum standard for care, Sheets said.
Lori Whelan of Blue Ridge was one of the activists who made the journey to the state capital Thursday. Having lost her leg to bone cancer, Whelan said she'd previously lived in California, one of seven states that have already passed laws requiring insurers to provide full coverage for prosthetics.
"Coming here was a shock," she said. Within four months of her arrival, her mechanical knee broke. Her insurer at the time did not cover the replacement, leaving her with a stiff leg and shaky knee. "It was buried in the fine print," Whelan said of the policy. It took her a year to appeal the claim, she said, and get the fix approved.