NEWS: Celebrity Helping to Raise Funds for Girl Who Lost Both Her Legs on Prom Night

How much for date with Jessica Biel? $30K
Money to help teenager who lost leg in accident
By: The Associated Press, CNN.Com, Thursday, July 20, 2006

DENVER, Colorado (AP) -- A date with Jessica Biel has raised $30,000 to help a teenager who lost her leg in a prom night limousine accident.

Jeanne Lee, an organizer of the event dubbed "Mollypalooza," told The Associated Press the winning bid came from a man who requested anonymity. The event Tuesday raised at least $44,000 to help Molly Bloom's family with medical expenses, Lee said.

Biel, Esquire's "Sexiest Woman Alive" and a former "7th Heaven" star, "has this opportunity to create a buzz that would provide some support and she's more than happy to do that," her father, Jonathan Biel, told KMGH-TV. He said it was his daughter's idea to hold the auction for a lunch date.

Biel, a Boulder native who is on location in Italy filming the movie "Next," was not at the fundraiser. In an audio message, she said, "I promise, I'm a cheap date."

Lee said the winner wrote a check but it had not been cashed as of Wednesday. The lunch date is set for August 18 when Biel is in town to receive a humanitarian award, she said.

Bloom was run over and dragged about 38 feet by a Hummer stretch limousine on May 13, police said. Limousine driver Stanley D. Sample, 38, faces a misdemeanor charge of careless driving resulting in serious bodily injury.

Bloom is undergoing rehabilitation at a Denver hospital.

Find this article at: http://www.cnn.com/2006/SHOWBIZ/Movies/07/20/people.biel.ap/index.html

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ACA's Campaign Staff Working for Your Prosthetic Needs!

ACA's Action Plan for People with Limb Loss (APPLL) team hard at work in the new Washington, D.C. office (Right to left: Jeremiah Perez (Action Campaign Assistant) Morgan Sheets (National Campaign Director) and Fred deGregorio (Development Director).

Ready to get involved with your home state prosthetic parity effort? No one should be without access to care or faced with annual caps imposed by insurance companies. Make a difference for people with limb loss in your state by getting involved and being a part of history!

Feel free to contact us to find out how you can help push for prosthetic parity: 202-742-1885 or appll@amputee-coalition.org

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NEWS: inMotion July/August 2006 • Volume 16, Issue 4

COVER STORY:
“Playing the Insurance Game”
Illustration by Karen AlleyDesign by Patrick Alley

Check out the latest edition of inMotion.

inMotion magazine is published bimonthly for amputees, caregivers and healthcare professionals, providing timely and comprehensive information.

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NEWS: Amputees look to lawmakers for help as more insurance companies shy away from paying for prostheses

By: Thomas Schultz, Santa Barbara News-Press, 5/31/06

Damion Miller says his medical benefits are good -- a key consideration for the union electrician who lost his left leg in a 1992 motorcycle crash. Still, the Santa Barbara man says, in the past six years, key elements of his coverage have declined.

"We still have considerably good insurance, but one of the things that just completely dropped out on me was my durable medical equipment, which is my prosthetic leg. Every two or three years I'm due for a new leg. Components start to wear out. My sockets change a little bit. Parts, you can imagine, like a car, wear out.

"I want to be normal like everybody else," he said. "My prosthetic leg gives that to me. Now that it's getting cut out of my medical, I don't know how long I'll even be able to stay working. Being active is only possible if I've got my medical durable equipment up to date."

Like patients across the state, Mr. Miller, 34, has faced the increasingly daunting prospect of recurring medical bills. Custom-fit artificial limbs, for example, can cost more than $10,000.

Amputees are watching how state senators handle a bill that would force insurers to recast coverage of prostheses to match the same terms and conditions as all other benefits in a health plan. In a 69-0 vote, the Assembly on May 15 approved the measure in what Assemblyman Pedro Nava, D-Santa Barbara, praised as an overwhelming bipartisan effort.

Supporters of the bill say changes are long overdue, describing case after case in which a patient is hard-pressed to pay for a medical necessity central to their everyday existence.

"It's a problem we run into on a fairly frequent basis," said Ralph Nobbe, a State Street prosthetist. "Passage of it will solve a huge problem for patients."

Opponents, mainly an array of health insurers, say the law would bring increased premiums and, as a result, leave more state residents without general medical coverage.

"It's got only to do with the fact that mandates have had a very negative effect on both the cost and quality of health care," said Susan Pisano, a spokeswoman for America's Health Insurance Providers.

"Opposition to bills such as these doesn't have anything to do with the merits of specific benefits. Rather, it has to do with the notion of mandates in general. We believe, and I think it's been pretty clearly demonstrated, that the thousands of mandates that there are around the country have made benefits packages so mandate-laden that in some instances, employers can no longer afford the coverage."

Although the bill would require insurers to beef up the coverage they offer, they still would not be required to provide benefits for prostheses.

With this in mind, Charles Bacchi, vice president of the California Association of Health Plans, said the bill could prompt employers to drop prosthetics coverage from policies they buy for workers, due to higher costs.
"If more folks are dropping the coverage, that is a bad outcome," Mr. Bacchi said.

The bill would amend the Knox-Keene Health Care Service Plan Act of 1975, deleting a requirement that prosthetics coverage be provided only under terms agreed upon between an insurer and policyholder.

The bill is sponsored by Assemblyman Bill Emmerson, R-San Bernardino, and the California Orthotics and Prosthetics Association, which argues that the current Knox-Keene language is too ambiguous, allowing health plans over the past decade to reduce their commitment to basic artificial limb coverage -- increasing the likelihood of chronic disability and injury among amputees.

Rudy Medina agrees.

The retired Santa Barbara County correctional officer lost his right leg to diabetes in December 2004 after a series of foot ulcers and infections. He loved his job, even though it kept him on his feet and walking on concrete during 12-hour shifts checking on inmates, he said, adding that it didn't help his situation.

"Of course, you never plan for something like this," said Mr. Medina, 58. "You always assume that if you're paying insurance, these things will be covered.

"You don't really need the extra burden of when you go to your insurance and they tell you, 'We don't cover that,' " he said. "It just makes it harder. Emotionally, you are going through a lot of things. Worrying about this shouldn't be one of those.

"What surprises me is I see people getting knee replacements," he said. "All that stuff is covered. I just couldn't fathom to see why a leg or a prosthesis that you need is not. It's not a cosmetic thing."

Because a new amputee's stump will shrink or change shape over time, temporary or training devices are typically employed until a more permanent prosthesis can be used.

Mr. Medina said his "practice" device cost $7,000, of which his Blue Cross HMO plan paid $3,000.
A more permanent device could cost him $15,000, he said.

"I've been kind of putting it off," Mr. Medina said. "We have the money, but my wife was thinking of retiring. Now she has second thoughts.

"It's not a question of whether you want to or not. It's a necessity," he said. "Nobody wants to live their life in a wheelchair . . . when there's another option."

After a while, a temporary prosthesis can become painful to wear, said Bear Hernandez, 59, a Raytheon technical engineer who lost a leg in June because of diabetes.

Although they can wear out much more quickly, his United Health Care plan allows Mr. Hernandez a permanent prosthesis once every five years, he said.

Under his Blue Shield plan, Mr. Miller, the electrician, is responsible for the first $2,000 of the cost of a prosthesis. Of whatever balance is left over, he said, his insurer pays half -- meaning a $10,000 device would cost him $6,000.
"That's a huge pay cut for me," Mr. Miller said. "All of a sudden it was like, I needed some new sleeves. I needed some repairs. Ralph (Nobbe) got the equipment and said, 'You owe me $2,000.' I was like, 'Wait a minute, for what?'

"If my leg breaks, it takes two months to fit me into a working leg again," Mr. Miller said. "If my leg were to break today, I'd be out of work for two months.

"Prosthetic limbs and legs have got to be brought into the realm of medical necessities," said the below-the-knee amputee. "If I don't have my leg, you know, I'm screwed. What kind of job can I do hopping around on crutches? Without my leg, what am I going to do, collect disability for the rest of my life?"

Larry Philip, 54, an offshore oil platform safety inspector, said his Blue Cross insurance provides a flat $3,000 a year toward his prosthesis.

He lost a leg to an ankle tumor in August 2004.

"This basic leg that I have doesn't even come close to what people need to take on a sports activity," he said, adding that he, too, will soon be due for a more permanent, $15,000 prosthesis.

"They are not durable medical equipment," he said, noting artificial limbs are so customized that they cannot be passed on to another individual.

Despite his frustrations, Mr. Philip said he feels even worse for amputees with no insurance. "What little bit of fortune I have, they don't even have that."

Up in Sacramento, Mr. Nava said he hopes the state Senate will throw its full support behind the proposed legislation.

"It's really important the people have the ability to maximize their potential," he said. "This is really about quality of life."

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Washington, D.C. Office Opening & Campaign Briefing

The Amputee Coalition of America is excited to announce the opening of a new office in Washington, D.C.!

The ACA has assumed the challenge to address and improve the health and care of people living with the loss or absence of a limb through the Action Plan for People with Limb Loss (APPLL). The ACA’s new space will serve as the headquarters for this important advocacy program.

This is an exciting step forward and we need your help to keep the ball rolling! Please join our campaign staff, local amputees, their families, support groups and healthcare providers who are working to make prosthetic coverage a reality throughout the country!

WHAT: D.C. Office Opening & Campaign Briefing
DATE: Monday, July 24, 2006
TIME: 6:30 p.m. to 8:30 p.m.
WHERE: 1436 U Street, NW, Suite #104, Washington, D.C., between 14th and 15th Street.

Light Refreshments will be provided!

PUBLIC TRANSPORTATION: The closest Metro is U Street/African-American Civil War Memorial/Cardozo (Green). It can also be reached on several bus lines including 90, 92, 93 and 96.

PARKING: Metered parking is available on the street.

RSVP: Registration is free. Please RSVP to Jeremiah at 202-742-1885 or jperez@amputee-coalition.org

We look forward to meeting you!

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We need your help to make prosthetic parity a reality!

Support ACA's campaign for prosthetic parity by purchasing a Limbstrong wristband! For just $1 you are publicly showing your support for this important effort.

To find out more or to purchase a wristband.

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Medicaid Access: Update from the Minority Health Initiative

Beginning July 1, all Medicaid applicants and enrollees who are U.S. citizens will have to provide documentation that proves their citizenship status and identity. This new requirement will undoubtedly create a significant barrier to health care for millions of low-income Americans, most of whom are from communities of color. Today, there are at least 9 million African Americans, 9 million Latinos, and 2 million other racial and ethnic minorities who will have to meet this burdensome and unnecessary requirement. You can learn more about the requirement by reading our latest issue brief, Citizenship Update: Administration Creates Additional Barries to Medicaid Enrollment.

There are many implications to this new regulation.

Find out more at: http://www.familiesusa.org/assets/pdfs/DRA-Citizenship.pdf

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MA: Parity bill dealt a set back.

The Massachusetts prosthetic parity bill was being advanced on two fronts. It was added as an budget amendment and advanced as a study in the Health Care Finance Committee.

Last Friday, we learned that the amendment did not go through. Speaker of the House Sal DiMasi would not allow it to moive forward.

With this avenue closed, the MSOP lobbyist will be working to see if they can get the bill pushed through the Committee.

This is a big disappointment, but the fight continues.

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