Legislation eases choices for amputees

Friday, October 31, 2008

WASHINGTON--Amputees could see better insurance coverage, thanks to a new Senate bill.

The Prosthetic Parity Act of 2008, introduced Sept. 18, would require private and group insurances to cover prosthetic devices similar to other major medical coverage.

“This will not only open up access, but avenues for (amputees),” said Greg Safko, president of the Board of Certification/Accreditation. “Amputees will no longer be on public assistance but leading productive lives, through jobs and education, children and adults.”

Many insurers, when they cover the services at all, cap benefits too low to cover the cost of a prosthesis. They also impose lifetime caps or only cover one prosthesis in a lifetime.

Such limits force hard choices for patients and their families, said provider Joe Sansone, CEO of TMC Orthopedic in Houston, Texas.

“We’ve got a 17-year-old girl, amputated at the hip, fighting cancer,” he said. “The limb she wants is $60,000. She has $2,500 in coverage. Now, does she go without; does her family go into debt; or do we give her less of a limb?”

On average, an adult amputee needs a replacement every five years. Children need them more frequently as they grow, according the Amputee Coalition of America.

There are nearly 2 million individuals living with limb loss, 70,000 under the age of 18, according to the coalition.

S.B. 3517 is a companion bill to another bill introduced in the House of Representatives in March. That bill, H.R. 5615, has enjoyed broad, bipartisan support and the same is expected for the new bill.

“In this year’s session it could be difficult to see passage of or momentum for the bills,” he said. “But this lays the framework for the next session.”