ACA Volunteer Opportunity!

Thank you to the 10 people who attended the volunteer night last month! With your help, we were able accomplish another fund raising mailing!

Save the date! The Amputee Coalition of America's (ACA) next volunteer night will be on Wednesday, May 16 from 6:30 p.m. – 8:30 p.m.

The ACA recently put out a survey demonstrating the widespread problem with insurance coverage for amputees throughout the country. It hammers home the need for prosthetic parity legislation!

The survey was done in partnership with Hanger Orthopedic Group, Inc. With their support, surveys were sent to facilities in 10 different states. The results were collected by the practitioners and office administrators. Personal identity information for individual patients was removed. ACA then compiled the data.

The surveys found that at least 38 different insurance companies are limiting coverage through various restrictions, including financial limits, increased co-pays and coverage exclusions. For the full report, click here.

Current restrictions include:

* No coverage for repairs or replacements
* Increased co-pays, deductibles and out-of-pocket expenses
* A cap on benefits if a patient receives a prosthesis from another insurance company
* Annual caps of $1,000 to $5,000
* $2,500 to $7,000 maximum lifetime cap
* One prosthesis per lifetime

With your help, this is all changing. With six laws on the books and 23 states in play already this year, over half the country is now part of this important campaign! This is what can happen when a national organization takes unprecedented steps to meet its constituents’ needs. However, this story is really about the progress that can be made when advocates, individuals, practitioners and industry partners work together. We look forward to continuing working with our members and partners to make even more progress! Volunteer time to support prosthetic parity.

What will volunteers be doing? Volunteers can choose to assist with a fund raising mailing, help with data entry, or make phone calls to raise awareness around the campaign.

Dinner and refreshments will be provided. In addition, volunteers who participate in three volunteer opportunities will receive two free movie tickets!

DATE: Wednesday, May 16.

TIME: 6:30 p.m. – 8:30 p.m.

WHERE: 1436 U Street, NW, Suite #104 , Washington , D.C. , between 14th and 15th Street

PUBLIC TRANSPORTATION: The closest Metro is U Street /African-American Civil War Memorial/Cardozo (Green Line). The Metro is about three long blocks to the office. The office can also be reached by several bus lines, including 52, 53, 54, 90, 92, 93, 96, 98, S1, S2 and S4.

PARKING: Reeves Center Garage. The entrance is behind the Reeves Center on U Street , just west of 14th Street across the street from Extra Storage Space. The flat rate is $7, or metered parking is available on the street.

R.S.V.P.: Please, R.S.V.P. to Jeremiah Perez at 202/742-1885 or jperez@amputee-coalition.org

Thank you for your continued support!

Read more!

NY and NJ Trying to Force More Coverage for Amputees

New York Public Radio
WNYC Newsroom

NEW YORK, NY April 17, 2007 —New York and New Jersey are among a dozen states where legislators are trying to force private insurers to provide more coverage for amputee prosthetics.

REPORTER: Paddy Rosbach from the Amputee Coalition of America says insurers generally provide an initial set of prosthetics. But as they wear out or the amputees’ bodies change, several insurers offer little or no coverage.

ROSBACH: If you have a child that is born with limb deficiencies and has to have an amputation, say, of both feet, and their insurer says they can only have one prosthesis for life, That’s the worst possible scenario.

REPORTER: The proposed bill in the New York Assembly and Senate would force insurers to cover prosthetics at least as thoroughly as the Federal Medicare system does for people over age 65.

Currently, six states have prosthetic parity laws including California, Colorado and Massachusetts. New York and New Jersey are among 11 more states considering such a measure. Opponents say adding mandates to insurers drives up the cost for everyone. Rosbach says that studies in states that later implemented the law suggest the cost ranges from 18 to 42 cents per insured person statewide.

Read more!

NEWS: Gunther and Bonacic seek medical coverage for prosthetics

April 18, 2007

Mid Hudson News

Albany -- Assemblywoman Aileen Gunther (D-Forestburgh) and Senator John Bonacic (R-Mt. Hope) Tuesday announced a bill they are sponsoring to require insurance companies to cover prosthetic devices.

“Individuals living with the loss of a limb face many obstacles, the least of which should be trying to persuade insurance companies to provide adequate prosthetic care to get on the road to recovery,” Gunther said. “We need to pass this important legislation so amputees can afford prostheses and avoid dangerous and costly secondary conditions.”

“This is a common sense measure that wouldn’t be necessary if health insurance companies allowed physicians to determine what is medically necessary for their patients,” said Bonacic. “However, because certain companies refuse to do this, we need to enact laws that protect and improve the quality of life for all New York’s patients, particularly, persons who have lost limbs.”

The legislation sponsored by Gunther and Bonacic was inspired by eight-year-old Chase Molinari from Roscoe in Sullivan County, who lost his leg during a battle with cancer as an infant. He was one of 200 amputees from around the state in Albany on Tuesday to show support for the legislation.

Read more!

NEWS: Roscoe boy makes pitch in Albany for prosthetic insurance

(Carrie and Chase Molinari testifying at the Albany Rally.)
By Brendan Scott
Times Herald-Record

April 17, 2007

Albany — It took Chase Molinari little over a month to learn to walk using the prosthetic leg that made him a statewide poster child for a major shortcoming of many private health plans.

Changing the system to make health insurers cover a larger share of artificial limbs has proved more challenging.

For six years, a bill inspired by the plight of the 8-year-old Roscoe boy has languished in a state Legislature wary about forcing new mandates on health insurance firms.

In that time, Chase has not only mastered the art of walking. He's also learned to ride a bike and play first base using a series of costly eight prosthetic legs needed to keep pace with his growth.

Today, Chase used his used his latest leg — a slim device that costs as much as a new Honda Civic — to stride up the steps of the Legislative Office Building. There, he joined local lawmakers as they renewed efforts to get Chase's bill signed into law.

"There's no reason that the insurance companies can get away with this," state Sen. John Bonacic, R-Mount Hope said. "When you talk of health care what could be more important than providing prosthetics to people without limbs?"

Chase and his parents were drawn into their struggle with the private health insurance system in 2000, when the infant's right leg was amputated to stop the spread of bone cancer.

Parents Keith and Carrie soon found that their insurance company would only cover a fraction — $1,500 — of the $7,000 cost of his first prosthetic.

They eventually got Chase certified as disabled to qualify for Medicaid. The state's taxpayer-funded health plans cover 80 percent of prosthetics costs.

The state law, which is sponsored by Bonacic in the Senate and Assemblywoman Aileen Gunther D-Forestburgh, in the Assembly, would essentially force insurance companies to match the level of coverage provided by the government.

They argue that doing so would make amputees more productive members of society and reduce other health costs down the road.

But the bill is just one of scores of health insurance mandates that legislators push each year. The health insurance industry says their passage can only result in higher premiums to consumers.

"For each of these proposals that comes forward, there is a very compelling human interest story," said Leslie Moran of the New York Health Plan Association. "We always have to weigh the affordability of insurance against the desire to have more expansive benefit coverage."

Read more!

NEWS: Caps on insurance coverage for prosthetics are targeted

A mandate included in a bill before the House could increase premiums, critics say.

By JASON CLAYWORTH
DesMOINES REGISTER STAFF WRITER

April 23, 2007


Brent Soderstrum found out about 1 1/2 years ago that his insurance would pay only half of what it would cost to fit him with an artificial leg.

The insurer, like many others across the nation, had placed an annual limit on payments for prosthetics.

Soderstrum, who lost his right leg in a car accident about seven years ago, spent almost $5,000 for the prosthetic leg that fits just above his knee. His insurance company paid $2,500. He was lucky - some prosthetics cost $30,000 or more.

Soderstrum, an attorney for a Des Moines law firm, said the issue isn't about his personal costs. He's fighting for other Iowans. "This bill is about what insurance should cover," he said.

Now, Soderstrum and others, including representatives from American Prosthetics & Orthotics Inc., are pushing Iowa lawmakers to pass a bill that bars such insurance caps.

The proposal, Senate File 508, has already passed the Senate and is on a list of unfinished bills in the House.

Opponents say the mandated coverage could increase insurance premiums.

"They create added costs to the policies that small businesses have to buy," said John Gilliland, a lobbyist for the Iowa Association of Business and Industry.

The caps for artificial limbs became widespread in insurance agreements about four years ago. Since then, Colorado, California, Maine, New Hampshire, Rhode Island and Massachusetts have passed legislation that requires companies to cover prosthetic care to the same extent that Medicare does, according to information from the Iowa prosthetic company.

Rep. Linda Upmeyer, a Republican from Garner, has offered a revision to the proposal that calls for a yearlong study to see whether the mandate is needed. In the meantime, the state would pick up the cost for people who don't have coverage.

"One of the things that worries me a little bit, the people really pushing this bill forward are the people who are making prosthetics," Upmeyer said. "Do we really have an issue here, or are we trying to sell more prosthetics?

Advocates say the increases in insurance costs would be minimal. Colorado lawmakers, for example, estimated their law would increase premiums by 12 cents per person per month for residents with health insurance.

"This is coverage Iowans used to have in their health coverage, and that coverage has been taken away," said Rod Cheney, president of the Iowa Prosthetic, Orthotic and Pedorthic Association.

Large businesses are often self-insured, which means they would be exempt from the mandate. Small businesses would be most directly affected, said Paula Dierenfeld, executive director of the Federation of Iowa Insurers. Small businesses currently can choose the level of coverage they desire.

"What I can tell you is all mandates increase premium costs. It almost goes without saying," Dierenfeld said. "By imposing the mandate, you would take choice away from businesses."

Reporter Jason Clayworth can be reached at (515) 699-7058 or jclayworth@dmreg.com

Read more!

NEWS: Patient Bears the Burden

Times-Herald Record
Opinion Section

April 24, 2007

It should come as something of a shock that insurance companies do not cover the costs of artificial limbs. It should come as something of a scandal that a bill to help correct this deficiency has, as a story put it last week, "languished in a state legislature wary of forcing new mandates on health insurance firms."

Instead, the children and adults who have lost their limbs to accident and disease, people who by any definition have a legitimate health need, have been sentenced to languish in their own way, paying the bills or major portions of the bills for devices that anybody with a brain and a heart can see are necessary.

Legislators interested in changing the level of coverage could not have found a better example — a boy whose leg was amputated because he had bone cancer and whose insurance company covered the usual durable medical goods portion of $1,500 for a prosthetic device that cost $7,000. The boy's parents learned, as do all parents of children with significant medical needs, how to become effective advocates, eventually getting him qualified for Medicaid, which covered 80 percent of the costs. Because he was young when he lost his leg and needed to get new ones as he grew, he languished repeatedly, sparing the insurance companies again and again.

Two local state legislators, Sen. John Bonacic and Assemblywoman Aileen Gunther, have introduced a bill that would force insurance companies to match the government coverage. Even that does not go far enough, but it is a good start.

Read more!