Amputee Videos: from Golf to Parity and More

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)

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.

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.

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

Kerth Langeneckert: Trucker, Harley Enthusiast, Amputee

Kerth Langeneckert drives a truck for a living and still loves to ride his Harley Davidson, but in 2005, he was involved in a motorcycle accident that left his left leg badly broken. After surgery, he developed an infection and eventually had to undergo an above-the-knee amputation. He describes himself as “being in a state of depression” after he lost his leg. After his prosthetist Dan Luitjohan made him a new leg, Kerth said, “It’s just good to finally get up out of a wheelchair or crutches and stand on two legs and actually walk on my own.”

Langeneckert’s insurance at the time of his amputation paid for his first prosthesis. His new leg even enabled him to go back to work driving a truck with a manual clutch. After two years, however, his residual limb has shrunk, causing the socket of his prosthesis, the part that fits over his leg, no longer to fit properly.

A poorly fitting prosthesis is very painful and can sometimes lead to blisters, infection, and sometimes new amputations or death. Prosthetic limbs do show wear and most amputees experience some change in the size of their residual limbs and require new sockets from time to time. And a new prosthesis may be required, sometimes every 3 to 5 years.

The private insurance Kerth has with this new job won’t pay for him to get a socket replacement so his leg will fit. How was his employer, a trucking company, supposed to know that $2500 is an unreasonable cap on annual prosthetic coverage? Parity legislation is needed in Missouri so working amputees like Kerth Langeneckert can continue to live with the quality of life they deserve.

The Fight for Prosthetic Parity Heats Up in Missouri and Across the Nation

Do working Americans who pay for health insurance deserve to walk again and return to work if a medical condition lands them with limb loss?

That’s the question before twenty-three state legislatures across the country. Parity laws require health insurance companies to cover prosthetic limbs when deemed medically necessary by a physician, without setting unrealistic price caps or once-in-a-lifetime clauses. When insurers fulfill their obligations, amputees are much less likely to depend on government services like Medicaid.Medicare, Medicaid, and the Department of Veteran Affairs already provide the coverage required by parity laws. But a movement to cut healthcare costs has led some private insurers here in Missouri to place annual limits on prosthetic coverage, ranging from $1500 to $4000, not quite half the cost of a below-knee prosthesis.

Insurance companies and government payers have always used provider contracts with companies like P&O Care to dictate how much they will pay for different types of prosthetics. But these new caps are imposed directly on patients, regardless of their different needs. Individuals and employers shopping for health coverage should not be expected to know that $1500 is an unreasonable cap on prosthetic coverage. In essence, these insurers are advertising that they cover prosthetics, but when patients need that coverage, it isn’t actually paid for.

One of P&O Care’s own patients, orthopedic surgeon Dr. Matthew Bradley (picture above), has testified before the Oregon State Legislature on behalf of a parity law that seems likely to pass there this year. Now, Matt has plans to use his expertise to help work for parity legislation here in Missouri. Through a new committee, P&O Care is joining with individual citizens, prosthetic providers, and advocacy groups all over the Show Me State to get a parity law passed here in 2008.

Besides Oregon, six other states have already passed prosthetic parity laws, including Colorado Maine, New Hamshire, Rhode Island, California, and Massachusetts, where former Governor Mitt Romney was a key supporter. Missouri Governor Matt Blunt has announced that he is supporting Romney’s bid for President: Does that mean he might support prosthetic parity, too?