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.]

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?