A group of more than 150 amputees from across the country plan to converge on Washington on March 10, urging members of Congress to support fair insurance coverage for artificial arms and legs. The Amputee Coalition of America, Knoxville, Tenn, has organized the gathering.

"Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all," says Kendra Calhoun, the organization’s president and CEO. "We intend to turn this tide, and our Lobby Day is a great example of the grassroots support we have from across the country to do so. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives."

The amputees and their families are making the trip to Washington to tell lawmakers that they need their own "bailout." While the Department of Veterans Affairs, the Department of Defense, Workers’ Compensation insurance, Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and even Congress’ health insurance plan cover prosthetic and orthotic devices, a growing number of group and private insurance companies cap the benefit so low that the average working family can’t afford adequate prosthetic care, the group says.

"Although an average adult amputee needs a replacement prosthesis every 5 years and children even more frequently, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely " Calhoun says.

Such practices pose especially grave challenges for families of children with limb loss, the group says. The Coalition put forth the case of Evan Light as an example. At 8, he is already on his fifth pair of prosthetic legs, and the last pair cost more than $20,000. Until the legislature in his home state of Indiana took action, his prosthetics benefit under the family’s insurance plan was only $4,000.

"Families like Evan’s are essentially penalized $20,000 or more because their child has grown and their arm or leg no longer fits," Calhoun says. "Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime. No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different."

Evan’s father, Randy, plans to attend Lobby Day with his son to support the legislation.

Senators Olympia Snowe (R-ME) and Tom Harkin (D-IA) and Representatives Robert Andrews (D-NJ) and George Miller (D-CA) are key sponsors of the bill, called the Prosthetic and Orthotic Parity Act. The bill would require employer-paid health plans to provide coverage for prosthetic and custom-fabricated orthotic devices on par with the coverage offered for medical and surgical services.

"People pay their monthly health insurance premiums and expect their coverage to take care of catastrophic situations like losing a limb," Calhoun says. "This is the very reason people purchase health insurance. No American deserves to be forced to continue using a device that no longer fits or is broken."

Statistics compiled by the Coalition show that passing legislation that ensures fair coverage for prosthetic devices will return people to work and ensure that there is no cost-shifting to government programs for coverage, the group says, adding that data indicates that the proposed legislation would cost less than 60 cents per member per month in insurance premiums.

Eleven states—Colorado, Maine, New Hampshire, Rhode Island, Massachusetts, California, Oregon, New Jersey, Indiana, Vermont and Louisiana—have passed laws that ensure fair coverage for prosthetics, and more than 30 states have legislation in various stages in their state capitols.

"These state laws have helped many people, but they are not enough," says Morgan Sheets, the Coalition’s national advocacy director, who is leading the Lobby Day activities. "Without a federal law, there will always be amputees who fall through the cracks."

Lorenzo Smith, whose right leg was amputated when he was 12, did just that. His mother, Albertha Jackson-Smith, recalls the day she had to explain to her young son that he couldn’t have an artificial leg because the family’s insurance wouldn’t cover it.

The Coalition is a national nonprofit organization that empowers people who have experienced amputation or are born with limb differences, through education, support, and advocacy.

[Source: Medical News Today]