New MCPLL Pay Pal Donation Button

It’s never been easier to support working amputees by donating to the Missouri Coalition for People with Limb Loss. In addition to the contributions that have come from prosthetic companies all over the Show Me State, we need every prosthetist and other concerned individuals to join the fight against the injustice that is keeping our patients down.

Times are tough for everyone right now, but every little bit counts! We know that we can get a prosthetic parity law passed in Missouri this year. Making your individual contribution is this simple: simply click on the “Support Prosthetic Parity” button below, and follow the instructions to pay with Pay Pal or any major credit card. Then check http://molimbloss.blogspot.com to see who else has contributed. Your name will show up there soon!

Share this page with your friends! We need your help educating and persuading all the new and returning representatives and senators in Jeff City that prosthetic parity makes good health care policy for working families and the entire State of Missouri during these financially troubled times.

Thanks to all those individuals who have made contributions so far!

Dan and Julie Luitjohan, Greg Doerr, Richard Haws, Richard Thiele, Rudy and Mary Kay Stecich, Kimberly and Donald Adkins, Joe Curotto, Fred and Pat Sexauer, Stephen and Angela Mestres, Dennis and Melinda Richards, Michael and Lucy Hey, Fred and Karen Vaught, Tonya Tebbe, Bill and Amy McLellan, Emily Zdenek, Marlene H. Mestres, Marlene M. Mestres, Tim Mestres, Richard Schumacher, John Rocky Reitmeyer, Fred Whiteford, Bill and Sue Brannan, Dixon and Barbara Smith, Walter and Carol Burkart, Shirley Luebbers, Paul Wunderlich, George and Denise Huber, Claire Willman, James and Barb Freeman, Maurice Graham, Todd Hilliker, Angela and John Gantzer, Robert and Margaret Beck, Ronald and Christine Roche, Dana and Sue Hockensmith, Dennis and Jo Ann Martin . . .

Northwest Kansas Diabetes Support Group : Prosthetic Parity in Kansas

Bill McLellan has sent you a link to a blog:

Advocates for prosthetic parity in Kansas are taking a different approach than Missouri and some other states. Instead of trying to change the law, they are trying to get the State's insurance board to change it's rules. For them, this requires 10,000 signatures on their petition.

Blog: Northwest Kansas Diabetes Support Group
Post: Prosthetic Parity in Kansas
Link: http://nwksdiabetes.blogspot.com/2008/10/prosthetic-parity-in-kansas.html

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STLtoday - Pinning blame on patients for costs won't lead to

Doug Ervine, Republican State Rep for the Health Insurance industry here in the great state of MO, thinks that people would take better care of themselves if they had to pay out of pocket more. Mary Jo Feldstein thinks otherwise.

read more | digg story

Now, Donate with PayPal

Whether you are a Missouri amputee, physician, rehab therapist, prosthetists, family member, or anyone else concerned that insurance companies cover prosthetics, you can support the cause for parity just by clicking the button below or in the column on the right. PayPal is an incredibly safe and easy way to pay online. You can set up an account or use your credit card. All proceeds go toward getting a prosthetic parity law passed in Missouri in 2009.

NPR.org - Mental Health Parity Approved With Bailout Bill : NPR

Bill McLellan thought you would be interested in this story: Mental Health Parity Approved With Bailout Bill : NPR
http://www.npr.org/templates/story/story.php?storyId=95435676&sc=emaf

*Listen/Watch on NPR.org*
Many stories at NPR.org have audio or video content. When you visit the link
above, look for a "Listen" or "Watch" button.
For technical support, please visit NPR's Audio/Video Help page:
http://www.npr.org/help/media.html

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Missouri Prosthetic Companies Should Financialy Support Parity

Recently, the MCPLL has had a harder time than expected getting financial support for prosthetic parity from the prosthetic industry here in Missouri, who should be the first to support this legislation. Working-age amputees are leading the effort, and they stand to gain the most in terms of quality of life. But prosthetic companies are the ones with the money who understand the issue and deal with the insurance companies most directly, and they also stand to benefit financially from the passage of parity legislation. That means they should pay the bulk of what it costs to get any law passed in our society (for good or ill), and that means paying a professional representative, also known as a lobbyist. However, it’s becoming more and more difficult to stay current on our payments to our lobbyist, Kent Gaines, who is doing an excellent job gaining strategic allies in the legislature.

At first, several companies jumped at the chance to give, so we had money in the bank, and some of them have even stepped up to shell out more money as it starts to run out. But fewer and fewer practices seem interested. Amputees in Missouri are urged to take a look at the list below, also found in the right margin, where it will be constantly updated as new checks and pledges come in.

Illinois does things differently. They have a professional association of prosthetists and orthotists that collects dues, and some of that money goes to its government relations efforts, including parity. Here in Missouri, efforts to get just such an association started led first to our highest priority, helping our patients get this law passed.

Here is the list of contributing prosthetic practices in MO, in alphabetical order, also available on http://molimbloss.blogspot.com:

• Advanced O & P (pledged)
• Central Brace Company
• Hanger O & P
• Lux O & P (pledged)
• O & P Design
• O & P Labs
• P & O Care

The following individual prosthetists have also made personal contributions:

• Dan Luitjohan
• Richard Haws
• Richard Thiele

Parity Fact Sheet: Good Medicine for Working Families

General Campaign Fact Sheet - Upload a Document to Scribd

Parity Bill Introduced in U.S. Senate

I was browsing through Workforce and I thought you would find this interesting:

http://www.workforce.com/section/00/article/25/77/62.php

Amputee Videos: from Golf to Parity and More

Missouri Coalition for People with Limb Loss Flyer

Missouri Coalition for People with Limb Loss - Upload a Document to Scribd

Read this document on Scribd: Missouri Coalition for People with Limb Loss

Prosthetic Parity: Saving Money, Saving Lives

Prosthetic Parity: Saving Money Saving Lives - Upload a Document to Scribd

Read this document on Scribd: Prosthetic Parity: Saving Money Saving Lives

BBQ and Washer Toss Raise $3,000 and Awareness for Prosthetic Parity

Quest for Parity in Kansas

Check out this blog on the quest for prosthetic parity coverage in Kansas. It sounds like Elizabeth Dole (R-NC) might introduce our bill in the U.S. Senate.

Update: Prosthetic Parity across the Nation

The cover story by Jennifer Hoydicz about prosthetic parity for the new issue of O & P Business News contains an update on the MCPLL’s efforts here in Missouri. You can read the full story here or the excerpt below:

The 2008 legislative session gave the Missouri bill a chance to begin movement. The bill was referred to the Senate committee and passed but session adjourned before the bill could be heard on the floor. Organizers, Jeff Damerall, Jean Freeman and Bill McLellan are all pleased with the movement and reception the bill has received thus far.

“We are looking forward to the next session in 2009 and having a prosthetic parity bill put forward in the House and the Senate,” Freeman said. “We were happy with the turnout for the Senate and the House hearings but particularly the House hearings. We had 20 to 30 individuals there … and it made an impression on the representatives.”

McLellan explained that the Missouri prosthetic parity bill was coupled with an autism parity bill and in the process was amended to become a mandated offer bill instead of a pure mandate.

“An offer … requires health insurance companies to offer to sell individuals and companies policies that include prosthetic coverage but not all of their policies have to include prosthetic coverage,” McLellan said. “So companies and individuals can choose to buy less expensive policies that don’t include prosthetic coverage. This was a compromise we were willing to make with the insurance companies in our first year.”

Despite the compromise, the bill stalled. The bill will be reintroduced in January 2009 to a better educated and informed group of legislators.

“We have made a lot of headway with individual legislators and bringing in that momentum which is helpful,” Damerall said.

When the bill is reintroduced, that momentum will be particularly important as they are expecting to enlist new sponsors for the bill as well as additional legislators for support.

“We are trying for everything we want,” Damerall said, explaining that they are aiming to change the language once again for full coverage. This time we are saying that if you provide individual coverage or group coverage, small group coverage, whatever coverage you are going to provide the benefit not just the offer.”

To continue the momentum and keep motivations high, the Missouri campaign is planning a number of events this summer which they hope will continue to raise awareness.

Bill has sent you an article of interest from Diabetes Health

Hi The Amputee Activist,

Bill (bmclellan@pandocare.com) has sent you an article of interest from
Diabetes Health. View the article by clicking the link below.

Amputee Coalition of America Enjoys Record Attendance at its National
Conference
http://www.diabeteshealth.com/read/2008/07/10/5827.html

Thank you,
The Diabetes Health Team
http://www.diabeteshealth.com
Subscribe online at: http://www.diabeteshealth.com

Amputee Coalition of America Parity Blog : SUMMER UPDATE: ACA Pulling Out All...

Bill has sent you a link to a blog:



Blog: Amputee Coalition of America Parity Blog
Post: SUMMER UPDATE: ACA Pulling Out All the Stops for the Parity Campaigns
Link: http://acaparity.blogspot.com/2008/07/summer-update-aca-pulling-out-all-stops.html

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Sound Bite

"Health insurance companies are going behind their customers' backs and capping their prosthetic coverage well below actual costs, or they are limiting amputees to one prosthesis per lifetime. We want to pass a law in Missouri that says they can't do that."

Letter to Prosthetists and Prosthetic Companies in MO

The following fundraising letter to Certified Prosthetists and Prosthetic Companies in Missouri was sent out Tuesday. I will be following up in the week to come.

[An alternative for those who wish to donate but cannot afford to give the recommended $250 or $2,000 for a company would be to pledge to raise the same amount. Prosthetists could raise $25 from ten friends or host an informational coffee night at their home. Prosthetic companies could host an open house and invite local doctors, therapists, politicians, and friends.]

Last year, the Missouri Coalition for People with Limb Loss (MCPLL) began its efforts to make sure your hard-working patients get the health insurance coverage they deserve. Now, we are asking for your help to guarantee that their voices get heard in the 2009 Missouri General Assembly.

You know better than anyone how ordinary people are being taken advantage of. They never imagined they would become amputees, but they did know they had health insurance for a reason: they paid into a system they thought would take care of them just in case a sudden trauma or unexpected diagnosis hit them out of the blue. You know that prosthetic coverage is not an unnecessary peripheral benefit, an extra, an add-on, or a luxury. Artificial arms and legs are the very things that health insurance exists to cover, because without them people cannot complete their rehabilitation from injury and amputation, and they cannot go back to work or lead an active, healthy lifestyle.

Prosthetic parity laws have now been enacted in eleven states, and all remaining thirty-nine states will file next year. Here in Missouri, we’ve already been through one trial run. During 2008 we learned the ropes, hired a fantastic lobbyist, testified at two hearings, and saw our bill pass out of the Senate Health Insurance Committee.

Now it’s time for everyone across the Show-Me State who genuinely cares about this issue to get involved. We are asking you to give $250 and for your company to give $2,000; check can be made payable to “Missouri Coalition for People with Limb Loss.” Every little bit helps, but these ballpark figures will help us reach our goal of $70,000 by January 1, 2009. Already we have more than 10% raised, and more has been pledged! These funds will go toward paying our lobbyist, Kent Gaines, as well as paying for letter-writing campaigns, publication of brochures and flyers, and trips to Jefferson City so that real amputees can meet with legislators. In the coming weeks, I will be contacting you to see if you are ready to join us in this cause.

Best wishes for your business and for the health of your patients,

Bill McLellan
Fundraising Chair
Missouri Coalition for People with Limb Loss
314-779-4641

Lacy Clay Supports Federal Prosthetic Parity Bill

U.S. Representative from St. Louis Wm. Lacy Clay supports the Federal Prosthetic Parity Bill and will even sign on as a co-sponsor, he told MCPLL Chair Jeff Damerall during the ACA's National Lobby Day in Washington D.C. last week.

Besides the oppressive 100 degree heat, Jeff and his wife had a fun time seeing the sights and meeting with law makers, including Missouri Senator Claire McCaskill and staffers for Senator Kit Bond.

A Leg for Louie (or Why South Carolina Needs a Parity Law...)

SUMMERVILLE, South Carolina — Amputee John Lewis loves volunteering for the Pine Ridge Fire Department, but charging into action on an old artificial leg can leave him weary and worn by the end of a call.

The prosthetic limb Lewis keeps in his fire boot is 15 years old, with a crack up the side and a knee socket that's falling apart. It rubs his shortened right leg raw over time.

"I ain't had to sit out any fires, but it's sure had me sore," said Lewis, who lost his leg in a motorcycle crash 29 years ago.

Lewis, 51, has another prosthetic limb for daily use, but that one has about five years of wear and tear on it. He's reluctant to take that one into a fire because his health insurance won't cover the cost of a new artificial leg. He figured he would have to make do.

That didn't sit right with his friend Angela Prosser. She figured if Lewis was willing to risk his life to help others, he should at least have a decent leg under him for support.

Prosser last week launched the "Leg for Louie" fundraising campaign to buy Lewis a new prosthetic limb. Models and prices vary, but she estimates that about $15,000 should get Lewis the leg he needs. "I think there will definitely will be an outpouring of support for something like that," she said.

The effort got a boost from North Charleston-based Floyd Brace Co., which offered to help cover about half of the cost of a new leg, Prosser said.

Larry Wiley, co-owner of the company, said he has known Lewis for years and considers him to be a true inspiration.

"Many who suffer limb loss look to others for safety and security. Louie dons his fire suit and his prosthetic leg and puts himself in harm's way to provide safety and security to our community," he said. "Truly amazing."

June 17, 2008 in Amputation | Permalink | Comments (0)

Summer BBQ and Washer Toss

The MCPLL will be holding a summer barbeque and washer toss August 9, from 4:00-8:00, at Des Peres Park near the corner of Manchester and Ballas Roads. The BBQ is one of two fundraisers we are hosting before the 2009 legislative session begins in January, and we hope to raise about $5,000 to help us get a prosthetic parity bill passed in MO.

Food and fun are free to the public, but donations are greatly appreciated!

Amputees fight caps in coverage for prosthetics

By DAVE GRAM
Associated Press Writer

SOUTH BURLINGTON, Vt. (AP) -- After bone cancer forced the amputation of her right leg below the knee, Eileen Casey got even more bad news: Her insurer told her that she had spent her $10,000 lifetime coverage limit on her temporary limb and that the company wouldn't pay for a permanent one.

"It was shocking to find out I was going to have to take out a loan to buy myself a leg so I could keep working and living independently," Casey said. At the bank, she said, she burst into tears when they asked what the loan was for.

Since then, Casey has joined a nationwide fight by amputees and the prosthetics industry to get the states and Congress to require fuller coverage for artificial limbs. The insurance industry is fighting the effort, saying such mandates drive up costs and reduce the flexibility customers want.

"The cumulative effect of several mandates can price employers out of the market altogether," said Mohit Ghose, who was a spokesman for America's Health Insurance Plans, an industry lobbying group, when he was interviewed recently for this story. He left the organization three weeks ago.

Vermont Gov. Jim Douglas recently signed into law a bill making Vermont the 10th state to require insurance companies to cover prosthetics as fully as they do other medical procedures. A similar measure is pending in Congress.

These laws say that if an insurance policy covers, say, 80 percent of the cost of any other medical procedure - whether a doctor's office visit or open-heart surgery - it must do the same for prosthetic limbs.

Just under 2 million Americans have lost a limb, with the largest number of amputations due to diabetes, said Paddy Rossbach, president and chief executive of the Amputee Coalition of America.

Simple prosthetic limbs range in cost from about $3,000 to $15,000. Those that are more mechanically advanced, or come with embedded computer chips, can cost up to $40,000. Expenses can grow further because many patients need new artificial limbs or sockets when the stump to which the prosthetic arm or leg is attached shrinks or otherwise changes shape. This is especially a problem in children.

While many private insurers have strict limits on the devices, government programs tend to be more generous. Medicare, the government health insurance program for the elderly, covers 80 percent of prosthetic costs and, unlike many private insurers, does not consider the more expensive mechanical or computerized limbs to be experimental.

The Veterans Affairs Department, which is seeing a growing number of amputees returning from Iraq and Afghanistan, provides prosthetic care without limits, said VA spokesman Terry Jemison. Anyone eligible for VA benefits - from a young soldier wounded in combat to an older veteran who has developed diabetes late in life - "will receive the latest in technology without limits on cost," Jemison said.

Rossbach argues that the health insurance industry's talk of mandates driving up costs is overblown. She said studies in six states that have passed these laws showed that increased coverage for prosthetics had added 12 to 25 cents a month to the average insurance premium.

She added that insurance companies' slowness to cover prosthetics can increase other health care costs in the long run, because patients' immobility often leads to other ills.

"If people have a very sedentary life, then they are going to be at risk for secondary conditions - diabetes, obesity, depression, some forms of cancer," Rossbach said.

Still, mandates are not the answer, America's Health Insurance Plans argues.

"Mandates misallocate resources by requiring consumers - or their employers - to spend available funds on benefits that they would otherwise not purchase," it says on its Web site. "They also limit consumer choice by not allowing health insurance plans to make innovative and efficient products available to employers and individuals, including mandate-free policies."

Many health insurers lump prosthetics under the category of durable medical equipment, which includes less-expensive items such as crutches and back braces. Many people do not realize until it is too late that they have signed up for coverage limits that won't come close to paying for prosthetics, Rossbach said.

To Casey, who sells advertising for a Burlington-area TV station, the result seems arbitrary and unfair.

"If I had breast cancer and had a double mastectomy, they would cover breast reconstruction, yet I can't have a leg? This makes absolutely no sense," she said.

An Arm or a Leg is Not a Luxury!

An Arm or a Leg is Not a Luxury! - Upload a doc

Read this doc on Scribd: An Arm or a Leg is Not a Luxury!

Fundraiser Ideas

Morgan and Dan also had some good ideas about fundraising. They said what we have planned is great. We should definitely try to get some press and local business sponsorship (good PR with their name on a banner or T-Shirt) for our two large events, maybe even see if a radio station could promote it. Additionally, they said the best way to raise money from individuals is to have amputees or others affected by amputation host parties in their homes or businesses, invite their friends and personal contacts, and try to raise awareness and small amounts of money from each person.

Summer picnics, BBQs, cocktail parties, drop-ins, and pool parties at private residences, and open houses at a prosthetic facility or other place of business are all good ideas. It’s hard to ask friends you know for money, but they’re the ones who are most likely to give. And they said summer time is a great time to get press, since news is slow.

Mandated Offer or Mandated Coverage?

I just got off the phone with Dan and Morgan with the ACA, and they were incredibly helpful. First, on the mandated offer issue: they said that the issue really comes down to whether insurance companies right now are cutting coverage completely or just restricting coverage with caps. Since in Missouri they are using caps and other clauses, a mandated offer would do the trick for us. The Federal bill is actually a mandated offer, a compromise they made since it would take forever to get anything at all in some states.

Morgan recommended that we not compromise on individual policies; some are regulated on the Federal level because they are self-insured, but we should insist that any mandated offer legislation cover both group plans and all individual plans regulated at the state level. And, we should make sure that when prosthetic coverage is offered, that coverage is at the level of Medicare without caps or other restrictions. Our negotiating strategy going forward could be that we come back with this kind of proposal, rather than completely playing hardball and demanding mandated coverage. The downside is that, as Jean and Suzi pointed out last night, amputees who need to get individual coverage may still face a pre-existing condition exclusion.

I need to get them the names of key legislators we hope to move to our side of the issue. Morgan said that they can help us get some targeted press in that legislator’s district and maybe organize a meeting of our supporters in their district. This is sometimes especially difficult for rural districts, and they said they could help; so if you guys remember who might have been on-the-fence with the power to make the bill move, send me the name. Maybe Kent can help with this, too.

Any more ideas, let me know. Hope all this is helpful. And please let’s dialogue about the mandated offer/coverage issue; we may want to start out asking for coverage and then compromise later on an offer only if we have to.

Prosthetic Parity Bill Passes out of MO Senate Insurance Committee

Last week, the Senate Insurance Committee voted to pass a prosthetic parity bill that would force health insurance providers to offer uncapped prosthetic coverage to employers and individuals. Now it needs to pass in the full Senate, the House Special Committee on Health Insurance, and the full House before going to Governor Bond for a signature.

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.

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 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.

Pre-Hearing Headquarters

Hello everyone,

I'm fairly new to the efforts of the coalition and would like to thanks all those who have been pushing for this equality. I am currently contacting as many patients as possible in the Mid-Missouri area to attend the hearing. Currently I understand from the HB2100 site that the hearing is at 5 PM in hearing room 5 on the first of April. Everyone is welcome to meet at my office in Jefferson City for staging or car pooling to the capitol which is approximately 5-10 minutes away. I am located at 2525a Missouri Blvd. Jefferson City, MO 65109 PH: 573-636-9611. I believe after spending time with some of the group members up at the capital having an outpouring of support and representation will be extremely vital.

Tracy Duncan Ell C.P.

Mid-MO Orthotics & Prosthetics
Jefferson City, Columbia, Lake of the Ozarks

We Got a Hearing! This is No April Fools!

There is a hearing for our Bill 2100 scheduled for the afternoon of April 1 before the House Committee on Health Insurance. It will be held at the Capitol Building in Jefferson City, MO. Below are the notices posted on the MO House website:

http://www.house.mo.gov/content.aspx?info=/bills081/hearings.htm

http://www.house.mo.gov/billtracking/bills081/bills/hb2100.htm

All amputees in the state of MO and anyone else concerned about this important issue are urged to attend! When you get to the Capitol Building, go to Hearing Room 5.

An Amputee's Experience

Wall Street Journal Covers Prosthetic Parity Issue

March 11, 2008


Insurers Pressed To Pay More For Prostheses

By VANESSA FUHRMANS March 11, 2008; Page D1

Big advances in technology have raised the costs of prosthetic limbs, and that has made them a target for cutbacks in health-care coverage.

Many private health plans cap prosthesis coverage at $2,500 or $5,000 a year, or pay for just one device per limb in a lifetime, sometimes even for a growing child. The most basic devices can cost between $3,000 and $15,000, while mechanically advanced or computer-assisted models can cost up to $40,000.

Now, amputees and prosthetic-device makers are pushing state legislatures around the country to pass laws that mandate prosthesis coverage. The goal is to force private health plans to offer coverage comparable to that provided by Medicare, which pays at least 80% of the cost of prostheses and allows regular replacement of artificial limbs. Health insurers oppose such mandates, saying they reduce consumer choice and drive up costs.

Prosthetic devices are among the biggest-ticket items affected by the growing effort of insurers and employers to curb rising health costs by asking patients to pay a bigger percentage of their medical bills. For people who need artificial limbs, the receding coverage can mean paying tens of thousands of dollars to fill the gap.

Sometimes, cuts in prosthetic coverage are tucked into a health plan's fine print, and employers and workers might not be aware of coverage limits. In plan benefit summaries, health insurers increasingly lump prostheses with durable medical equipment -- a catchall category that also includes crutches, wheelchairs and other less expensive items. So accepting a $2,500 cap on such equipment in exchange for a lower premium increase might seem like a reasonable deal, until the employer or employee realizes that the cap counts toward costly prosthetic limbs as well.

Until two years ago, Caitlin Palmer's below-the-knee prosthesis was covered at 100% through her father's health plan. Caitlin, whose leg was amputated shortly after birth due to a defect, is now a 14 year old in her school's color guard who is still growing. She's already gone through 10 prostheses, even though the family had stretched the life of a few "with duct tape," her mother, Michele Palmer, says.

But when the Palmers submitted a claim for a recent repair, they discovered that the plan, insured by Independence Blue Cross, now paid only 50% or 75%, depending on whether the work was done by an in- or out-of-network prosthetist.

A spokeswoman for Independence said Mr. Palmer's employer, a municipal township in eastern Pennsylvania, had switched to a plan with a lower premium increase, but more employee cost-sharing. When Mr. Palmer told his employer about the change, "they were so upset for him. They didn't realize," Mrs. Palmer says, adding that she worries how the family can afford its share of future prostheses.

So far, eight states have passed laws mandating prosthetic coverage comparable to that offered by Medicare. Among the earliest such laws, California, Massachusetts and Rhode Island passed theirs in 2006, while New Jersey enacted legislation in January. Similar legislation has been under consideration recently in 27 other states, but faces stiff resistance in some places.

Unlike many private insurers, Medicare doesn't consider more expensive computer-assisted artificial limbs as "experimental" and covers them, too. The government health-care program for the elderly also generally allows replacement of prostheses every five years.

Health insurers say mandated coverage denies consumers and small employers the option to buy less expensive plans without benefits they may not want or need. "The issue isn't the merits of any single mandate," says Mohit Ghose, a spokesman for insurance lobby America's Health Insurance Plans. "It's what mandates collectively do to the affordability of health insurance."
Proponents of mandates say the added coverage would cost just pennies in monthly premium increases, given that there are fewer than two million Americans living without a limb. Equipping amputees with an artificial leg or arm that keeps them active and productive, they say, also prevents other medical costs and complications, such as back problems or obesity.

"You'd think that there isn't anything more basic than making sure someone has an arm and leg," says Keith Molinari, who found his private health insurance covered only a fraction of a basic prosthesis when his 10-year-old son, Chase, lost his leg to cancer as an infant. The Molinaris, in Roscoe, N.Y., made what they say was an emotionally difficult decision to have their son, who outgrows his artificial legs nearly every year, declared disabled so he would qualify for Medicaid, the joint state/federal program for the poor. Mr. Molinari has since changed jobs and now is enrolled in a plan that provides adequate coverage for prostheses.

The Amputee Coalition of America, an advocacy group backed by both prosthesis makers and individual amputees, has launched a campaign to introduce a bill in Congress. A big backer of the effort is Hanger Orthopedic Group Inc., the biggest player in the $2.5 billion U.S. prosthetics market. The coalition plans to enlist amputated Iraq war veterans -- many of whom have state-of-the-art prostheses through veterans' benefits -- to help make the case.

Amputee advocates face an uphill battle in some states. Five years ago, a grassroots effort in Virginia succeeded in getting a bill introduced but then stalled at the level of an advisory commission. More recently, Virginia Prosthetics Inc., the state's biggest prosthesis maker, spearheaded a more organized campaign, hiring consultants and at one point last fall chartering a bus to bring nearly four dozen patients and family members to testify before state legislators.
The emotional testimony helped the proposal pass out of the commission and two committees. But the state senate shelved the bill last month. According to state estimates, the additional coverage would have raised consumers' monthly premiums on average less than 25 cents a month.

Reginald Jones, an attorney representing the Virginia Association of Health Plans, says small businesses bear the brunt of the cost of state insurance mandates, because most large-employer health plans are governed by federal law. "There's a tradeoff," Mr. Jones says. "It's probably more important to have more people insured with basic coverage and fewer uninsured, than a few people insured with a lot of coverage."

Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com

Prosthetic Parity Action Alert

On behalf of the Missouri Coalition for People with Limb Loss, I am excited to let you know that House Bill 2100 has been referred to the Special Committee on Health Insurance. This bill requires health insurance companies that claim to cover prosthetics to pay Medicare allowable rates without capping coverage at ridiculously low levels.

Real prosthetic parity is within our grasp! If we can get a hearing scheduled, we can all go to Jefferson City, drum up some publicity, and make our case before our legislators in public. Otherwise, our effort will fail this time around. It is absolutely necessary that as many Missourians as possible contact the committee chair, Rep. Wilson, as well as your own legislators, and ask for a hearing! Here is some information to make that easier for you to do right away. Please, take the time to stop what you’re doing and make just one or two phone calls or e-mails. What you do will make a difference!

Representative Kevin Wilson, Chair, Special Committee on Health Insurance
Home Zip: 64850; Counties: McDonald, Newton; District 130
Capitol Phone: 573-751-9781
E-mail: Kevin.Wilson@house.mo.gov

Everyone, please call and/or e-mail Rep. Wilson and say:
Please grant a Hearing for House Bill 2100 concerning prosthetic parity.

If you would like to say more, here are three quick talking points you can include in a phone call or cut-and-paste into an e-mail:

1. Employers, working Missourians, and amputees are being deceived into thinking that prosthetics are covered in their policies when, in fact, payment is capped at less than one-fourth to one-half the cost.
2. Some working-age amputees have found it better to get on Medicaid or Disability instead of returning to their jobs because coverage is better than with private insurance.
3. The cost of prosthetic parity laws on private health insurance is somewhere between 12 and 25 cents per member per month, or less than $3.00 per year.

Also, include any personal information, especially if you are an amputee or have been affected by insurance caps on prosthetic coverage.

If any of you or your patients or friends live in Rep. Wilson’s district, please get them involved!

Here is a list of all the members of the insurance committee. By clicking on their name you can immediately send them an e-mail.

Wilson, Kevin, Chair
Kraus, Will, Vice Chair
Bland, Craig C.
Grill, Jason
Hubbard, Rodney R.
Kratky, Michele
Pollock, Darrell
Portwood, Dr. Charles R.
Sander, Therese
Sater, David

Please check and see if your legislator is on this list, either by clicking on their name or by looking up your rep here: http://www.senate.mo.gov/llookup/leg_lookup.aspx . You can send an e-mail or make a phone call and say the same things listed above for Rep. Wilson. Once we get a hearing, we can go from there.

Thank you for your participation in this worthy cause. Feel free to forward this blog post to anyone, especially other amputees, whom you think will want to get involved. For more information, continue to check our blog at http://molimbloss.blogspot.com/.

Va. Senate sends bill on prosthetics insurance back for study

Below is a brief news story from Virginia that shows a little of what we're up against.

Some small business folks (definitely not all) are under the impression that prosthetic parity will significantly increase their costs. In fact, the marginal cost increase of $0.10 to $0.25 per member per month will be greatly offset by amputees returning to work.

Plus, we believe that even if the cost-benefit analysis were not so clear cut, this is a justice issue the State of Missouri should deal with. Individuals and their employers who sign up for insurance policies that claim to cover prosthetics should actually get coverage that isn't capped at less than 25% of what a simple below-knee prosthesis costs. And a small slice of the population--amputees and potential amputees--should not be taken advantage of in order to reduce costs (ever so slightly) for everyone else.

By Kate Wiltrout The Virginian-Pilot© February 11, 2008
RICHMOND

The Senate today voted to shelve a bill that would have required insurance companies in Virginia to cover the expenses for prosthetic devices.

Sen. Patsy Ticer (D-Alexandria) sponsored SB 645, a bill she first proposed in 2006. The idea was sent to a joint legislative audit review commission, which recommended mandating prosthetics for patients who lose a limb or part of a limb. State and federal insurance plans already cover prosthetics, as does the military and Medicaid. But because high-tech limbs can cost upwards of $80,000, many private insurers cap their coverage at a level that makes it impossible for amputees to get replacement limbs recommended by their doctors.

"This benefit will not cause a single business to drop health care benefits for their employees," Ticer said before the vote. "This bill will keep some Virginians from turning to Medicaid, even if they have health insurance."

Sen. Frank Wagner (R-Virginia Beach) recommended sending the measure back to the Commerce and Labor Committee for further study next year. Wagner, a business owner, bemoaned the increasing costs of providing insurance to employees. The Senate voted 23-17 in favor of Wagner's motion

House Bill 2100!

True to his word, Rep. Cooper filed the prosthetic parity bill! Click here to read House Bill No. 2100 or here for updates on its progress.

It was read for the first time on February 12. It was read for the second time on the 13th. Rep. Cooper is listed as the sponsor and Rep. Avery as the co-sponsor.


Please call your State Representative and ask him or her to vote for House Bill 2100. We will let you know when a similar bill has been introduced in the Senate and when any hearings have been scheduled.

Super Tuesday!

On behalf of the Missouri Coalition for People with Limb Loss, I want to let you all know what a successful day we had in Jefferson City yesterday, February 5, 2008. For us, it really was a Super Tuesday! We found three Representatives enthusiastic about sponsoring our bill for prosthetic parity: Rep. Dr. Wayne Cooper (left), Rep. Jim Avery, and Rep. Rick Stream.

Dr. Cooper is the Chairman of the Health Policy Committee, and he committed to giving our bill a hearing. After lunch, we were able to also get the support of Senator Griesheimer, who will sponsor our bill and introduce it to his committee for small business and insurance.

At this point, our next step is to wait for the draft bill we gave Dr. Cooper to be drawn up with the right language. In the meantime, we need to start contacting amputees who might want to travel to Jefferson City for the hearing, whenever that is. Once we have a bill introduced and a hearing scheduled, we can begin to make phone calls and write lots and lots of letters to those Reps on the committee, hopefully from people in their district.

Next Trip to Jefferson City

Memebers of the Coalition will be going to Jefferson City again on Tuesday, February 5th. If you would like to come along and speak with legislators to tell your story or express your opinion, please contact Jeff Damerall at (314) 965-2255 (extension 17).

Activists Visit Senators

From Left: Bill McLellan (P&O Care), Jeff Dameral (Chairman), Jean Freeman (Secretary; O&P Design), Jim Weber (P&O Care).

Last Tuesday, activists from the Missouri Coalition for People with Limb Loss visited Jefferson City for appointments with two Republican Senators. Senator Kevin Engler, Majority Whip, and Senator Scott Rupp both expressed sincere support for prosthetic parity. They did not know and could not believe that insurance companies in Missouri claim to cover prosthetic limbs while capping coverage at less than a fourth of what they actually cost.

While Republicans generally have a hard time with insurance mandates, they agreed that prosthetic parity is not a traditional mandate. It simply requires insurance companies to cover what they claim to cover and stop taking advantage of employers and individuals who have no idea how much a prosthesis costs. Senators Rupp and Engler, as well as other Representatives we met with in the hallways of the State Capitol, want working Missourians who tragically and suddenly loose limbs to be able to return to work instead of becoming dependent on Medicaid.

It looks like prosthetic parity has broad bi-paritisan support in Missouri, but we are still looking for a Republican Senator and Representative who has the time and dedication to sponsor our bill in their houses of Congress. It takes more than sincere support; we need to become a priority on the 2008 legislative agenda, and for that to happen, individuals across the state need to contact their Senators and Representatives and write letters to the editors of their local newspapers in support of prosthetic parity legislation.

Most persuasive are the personal stories of working Missourians like Jeff and Jean who lead the Missouri Coalition, real people who have suffered from hidden caps on prosthetic coverage.

Morgan Sheets: Letter about State and Federal Prosthetic Parity Bills

Dear Editor: Currently, due to archaic insurance regulations, prosthetic care is being put out of reach for many amputees in Wisconsin. Insurance plans are restricting or even eliminating coverage for prostheses. This is a matter that Congress must address.

In return for premiums paid for private health insurance, consumers expect to be covered for catastrophic illness or injury. They expect that their monthly premiums will provide them with the most basic of care, including prostheses.

Policy reports regarding prosthetic parity laws from Colorado, Massachusetts, California, New Jersey and Virginia suggest that the costs are minimal -- anywhere from 12 to 25 cents per member per month.

If amputees are prevented from accessing prosthetic care, this increases state Medicaid costs due to complications. The subsequent cost to the health care system far exceeds that of providing prosthetic care, while the lack of productivity places a huge burden on society.

Prosthetic parity bills have been launched all over the country, including in the state of Wisconsin. A federal prosthetic parity bill is going to be introduced next year. This bill would ensure that prostheses are treated the same as other basic, essential care.

Please urge your member of Congress to co-sponsor the federal parity bill when it is introduced. We must give people with limb loss the care they need to fully participate in society!

Morgan Sheets, national advocacy director, Amputee Coalition of America, Washington, D.C.A letter to the editor.

Let's start compiling our stories!

The Amputee Activist is the new blog of the Missouri Coalition for People with Limb Loss. We want it to be a place where amputees and their friends can share stories about our experience, especially the hardship created by unfair hidden caps on prosthetic coverage in private healthcare insurance policies.

Contact Bill McLellan at bmclellan[at]pandocare.com if you would like permission to contribute new posts to this blog. Anyone can post a comment on any blog post without an ID from Google or Blogger, but authors of new posts will need to get an ID. All you have to do is register your current e-mail, if you don't want a new gmail account, and create a password.

Benefits of Prosthetic Parity Legislation

• Allowing individuals to return to work (and to paying taxes) following the loss of a limb with a moderate increase of monthly insurance premiums estimated from 12¢ to 35¢ per member per month.
• Preventing the onset (or delaying the onset) of secondary conditions.
• Cost savings in unemployment insurance, state employment and training programs, rehabilitation and counseling programs, and other social welfare programs. [It is estimated that every dollar spent on rehabilitation, including prosthetic care, saves more than $11 in disability benefits.]
• Preventing individuals from going into or furthering debt. [A growing number of group and private health insurance companies are capping prosthetic benefits at levels like $2500 or $4000 when the average cost of an above the knee prosthesis is $15,000-$20,000 and a below the knee prosthesis is $8,000-$10,000.]