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