A few years ago I joined in the fight to help bring a change to the laws in Texas regarding insurance coverage for prosthetic devices. Currently it is up to the individual carrier to provide, or NOT provide coverage for prosthetics to those persons with limb loss. Many insurance policies limit coverage to $2,500 OR Less per year. The amputee is frequently called upon to fund the majority of the cost of prosthetics after having purchased medical insurance that was expected to cover the cost of a medical catastrophe when their deductible had been met. According to the Texas Coalition for Insurance Parity, the average cost for a basic below the knee prosthesis is $7,500, and a basic above the knee is $13,000. That puts quite a financial burden on an individual who is already dealing with a dire personal traumatic experience. “Horror stories” have been related to me, one woman said, “My teenage son recently had to have both his legs amputated due to a life threatening infection. My insurance company tells me that he is limited to one prosthesis for life. One mother said, “My six-month old son was born with his left leg missing above the knee. When I contacted my insurance company I found that reimbursement for prosthesis is a maximum of $1000 a year”. Sadly these stories are fact, and demonstrate the challenges faced by persons with limb loss. Over half the people with limb loss that need prosthetics either pay out of their pocket or go without. My story is somewhat different from most of the amputees that I have met over the years, in that I was born with a birth defect, and have walked with the help of prosthetics since the age of 2. When growing up I was fortunate enough to have my prosthesis provided to me by Shriners Hospital for Children in Philadelphia, and later Texas Scottish Rite Hospital here in Dallas. In 16 years I probably had 8-10 different prosthesis. As an adult I was shocked by the cost of my prosthetics, even with “Good Insurance” I paid just over $17,000 for the one I am wearing now…..but I got it in 1989! Recurring repairs cost me $1,500 on average, and were not covered by insurance. In 2001 I had an accident and injured my good leg and was immobilized as a result. During the time that I was down, I gained almost 40 lbs, and started to really have difficulty walking. I needed a new prosthesis, but discovered that the one I wanted was going to now cost about $40,000. As a result of not having a proper fit, and my increased weight, I developed degenerative arthritis in my “Good Hip and knee” I was diagnosed with Chronic Overuse Syndrome, my good leg was simply wearing out. Could a new properly fitting prosthesis, somewhere in the last 18 years given me less wear and tear on my good leg and extended my productive years? The doctors all seem to think so. I started drawing Social Security disability last year, and have received benefits in 1 years time equal to the approximate cost of a new prosthesis. If my insurance company had covered prosthetics, I would most likely be working full time and paying into Social Security, rather than drawing benefits. And we wonder why Social Security is in trouble….how many more like me are out there? I feel confident that I am not alone, and that many other amputees face the imminent deterioration of their “Good Legs” should insurance laws stay as they are. Ironically, now that I have been labeled Disabled, I can now get the prosthesis that I need through Medicare. Without Parity, private insurance companies are free to set limits wherever they want. So how did this happen? Over the years, health costs have risen, and many employers have shopped around in efforts to keep the cost of benefits they offer employees under control. The insurance companies in return have looked for ways to be competitive, and prosthetic coverage has wound up on the cutting room floor in efforts to “Save Money”. When approached with what seems to be a good plan, many employers who have no amputee employees don’t even give prosthetic coverage a thought. Later they discover that the “Deal “ wasn’t so great after all. The employer becomes a victim as well when realizing the reality of their employee’s personal and financial crisis. In January 2007 I was part of a “One-legged Army” that marched on the Capital building in Austin, Texas. When it was my chance to speak I held up a table leg to illustrate my point, saying “Under my current insurance plan, this (the table leg) is the only leg I can afford”! Our goal was to gain awareness and support for House Bill 223 authored by Representative Pete Gallego, and Senate Bill 54 authored by Senator Judith Zaffirini that would deal with the issue of Prosthetic Parity. Prosthetic Parity Law requires that the coverage offered be equal to or better that offered by Medicare (80%). Laws that have already been in affect in 6 states, have actually saved money rather than cost it. In Colorado, the Department of Health Care Policy attempted to identify some of the areas of potential improvement. Savings in overall medical costs experienced by clients utilizing the new adult prosthetic and orthotic benefit were identified. There was a net savings of $195,482 or $1,177.60 per client! This new coverage only cost the individual policy holder only about.12 cents per month. Watch the video of this event at: http://www.news8austin.com/content/your_news/default.asp?ArID=178400
Committee. Unfortunately, in the year of bad precedents, the bill died in the Calendars Committee. SB54 was held without a hearing in a sub-committee of the Senate State Affairs Committee, chaired by Sen. Tommy Williams (R- The Woodlands). The 80th legislature closed for the session without enacting prosthetic parity and will not re- convene until 2009. This gives us plenty of time to plan a winning strategy. I believe that in order for us to be successful in getting Parity laws passed in 2009, we must rally support from the able bodied.
are over 2 million amputees in the United States alone, and over 100,000 new amputations per year. With diabetes and obesity rampant in this country and the War in Iraq, it’s just a matter of time before someone who is dear to you will be touched by this issue. Don’t wait until faced with tragedy to do something about it.
Write your representatives and congressmen ad senators and let them know that you support Prosthetic Parity and you’ll be happy to pitch in to help pay for it. Come out to the Monster Energy Disc Games October 24th and 25th , sign our petition, and find out more about it go to www.discgames.org or e-mail rmecca57@yahoo.com.. Contribute to discgames.org and their efforts to increase awareness. All we want is to lead productive lives without having to bear an undue financial burden to do so. The passing of Prosthetic Parity laws in Texas will make this possible. . We want Parity not Charity Randy Mecca |
| Disc Games .org |
| It’s the Battle Cry of Amputees across the country…….. We Want Parity Not Charity ! |
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