Prosthetic bill: 'It's a no-brainer'

Monday, May 24, 2010

WASHINGTON - A bill that seeks better insurance coverage for prosthetic limbs was introduced in the Senate April 16.

Co-sponsored by Sens. Tom Harkin, D-Iowa, and Olympia Snow, R-Maine, the Prosthetics and Custom Orthotics Parity Act would require insurers to include the devices under major medical coverage.

"It's a no-brainer," said Joe Sansone, CEO of TMC Orthopedic in Houston, Texas. "With the limb, you can get back to work and take care of your family. Without one, you are more likely to be wheelchair-bound and less likely to work."

While most major insurers do provide some coverage of prosthetic devices, they often have lifetime caps or other limits on coverage, which can put the devices out of reach for many patients.

"We had a young lady who lost her leg to osteosarcoma," said Sansone. "Her new limb was going to cost $70,000 and her father's insurance only covered $2,500."

The Senate bill is a companion to H.R. 2575, introduced in May 2009, which currently has only 17 co-sponsors. Part of the reason for the lack of momentum: Both bills include custom orthotics.

You can only mandate so much, says Dr. John Rush, a longtime advocate of prosthetic parity who has helped get similar legislation passed in 18 states. When custom orthotics get thrown into the mix, it tends to slow things down, he said.

"When you just talk about prosthetics, it's an easier sell," said Rush. "There's less opposition from the insurance companies, who know they are on the losing side (when it comes to coverage for limbs)."