March 12, 2008
In the face of drastically reduced health insurance coverage for prosthetic care, the largest national non-profit educational and advocacy organization representing nearly 2 million amputees is calling for federal legislation requiring health insurance companies to cover prosthetic care on par with other essential medical care.
“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,’” says Paddy Rossbach, president and CEO of the Amputee Coalition of America.
“A solution to this problem is federal legislation requiring health insurers to provide meaningful coverage for prosthetic care and eliminate any distinctions between prosthetic care and other essential medical care covered by their policies,” Rossbach says.
“Federal legislation is needed to close the insurance coverage gap,” she adds.
"Individuals who have undergone an amputation of an arm, leg, hand or foot, and children born with limb loss or difference, face many obstacles in their recovery and in their daily routines. Not being able to pay for limb replacement needed to attend school, return to work and lead independent, productive lives shouldn’t be among them," Rossbach says.
“Thousands of people who face the trauma of limb loss also face additional shock when they discover that their insurance company will not pay for the prosthetic limb that will enable them to return to an active and productive lifestyle, support their families and contribute to society, rather than burden it,” Rossbach says.
“It’s a sad situation when a health insurance plan, whose ever-increasing premiums have been paid for years by individuals and their employers, forces its members to rely on community fundraising bake sales and other sources of charity to pay for prosthetic care for themselves or their children or other family members,” Rossbach says.
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 Amputee Coalition, among respondents with private health insurance, 24 percent had experienced a reduction in prosthetic coverage over the past three years. Four percent had their coverage eliminated entirely.
“When individuals discover that prosthetic care is not covered by their health insurer, or it is extremely limited, they may have to resort to using retirement funds or children’s college savings to purchase the prosthesis they need,” Rossbach says. “Some individuals in this situation have even taken mortgages out on their homes to get the prosthesis they need.”
"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 healthcare system if this is not done far exceeds that of providing prosthetic care, and places a huge burden on society," Rossbach says.
“Congressmen on both sides of the aisle are working with the Amputee Coalition and other advocates on such legislation,” said Rossbach, “including Representatives Rob Andrews (D-NJ), Judy Biggert (R-IL), Lincoln Diaz-Balart (R-FL), Ric Keller (R-FL) and Todd Russell Platts (R-PA).
Rossbach sees momentum for federal parity legislation created by laws recently passed in eight states, and pending in 31 others, requiring health insurers to provide meaningful coverage of prosthetic care. In 2000 Colorado was the first state to pass such a law. New Jersey is the latest state to pass prosthetic parity legislation earlier this year.
“Continued focus on state bills is essential. It helps the states achieve insurance parity while providing additional awareness and support for federal legislation,” Rossbach says.
The Amputee Coalition of America, based in Knoxville, Tennessee, is a national, non-profit consumer educational organization that empowers people who have experienced amputation or are born with limb differences through education, support and advocacy. The Amputee Coalition includes individual amputees, amputee educational and support groups, family members and friends of amputees, physicians and other health care and rehabilitation professionals, prosthetists, amputation or limb loss related agencies and other organizations.
Source: Amputee Coalition of America
