ALBANY– A bill calling for equity for prosthetic coverage in health insurance policies was the focus of a rally in Albany. Assembly Bill 1274 and Senate Bill 1672 would affect people with limb loss who are currently insured and would guarantee that unfair and inequitable exclusions, caps and restrictions could not be imposed by insurance companies.

"Individuals who have undergone some type of amputation, such as an arm, leg, hand or foot, and children who are born with limb loss or difference, face many obstacles in their recovery and in their daily routines. Not being able to pay for limb replacement to return to work or lead productive lives shouldn’t be among them," said the lead sponsor of the Assembly bill, Assemblywoman Aileen Gunther.

Activists gathered at the state capitol to push for a public hearing for the prosthetic coverage bills. Activists met with the Chair of the House Health Care Committee, Assemblyman Richard Gottfried, the Chair of the Senate Insurance Committee, Senator James Seward and several members of the leadership.

Assembly Bill 1274 and Senate Bill 1672 would require health insurance plans to cover the fitting and repair or replacement of a prosthetic device and/or component if determined to be medically necessary by the prescribing physician. Currently, coverage varies among health insurance companies that sometimes evaluate coverage on a case-by-case basis.

"In return for premiums paid for group health insurance, consumers expect to be covered for catastrophic illness or injury. Sadly, without legislation to ensure coverage, many insurers are curtailing, or even eliminating coverage that people expect to be there in the tragic event of limb loss," said Morgan Sheets of the Amputee Coalition of America (ACA). The ACA is currently coordinating a national campaign for prosthetic coverage legislation. New York is one of 24 states currently advancing prosthetic coverage bills. Seven states already have laws in place.

In a recent statewide survey, the Amputee Coalition of America (ACA) found at least eight different companies in New York that are restricting or eliminating coverage for prosthetics. The restrictions vary from financial caps of $1,000 or $2,500 to excluding repairs or even limiting a person’s benefit to one prosthesis per lifetime.

"It’s very shocking and heartbreaking for people who have already suffered the trauma of limb loss to find out that their insurance carrier will pay only on a very limited basis or not at all when it’s time to be fitted for a prosthetic limb," said Elfie Knecht of New York City.

"Prosthetic limbs allow people to return to their work; they allow people to return to their life," said Janie Tice Shepard, a physical therapist from the Hudson Valley. "Not only does providing prosthetics cost very little to the general insurance population, but it also saves money in the long run."

New York taxpayers are currently paying for insurance companies short sighted regulations. If amputees are prevented from accessing the care they need to be productive members of society, this increases state Medicaid costs due to complications such as flexion contractures, skin breakdown, osteoporosis, muscle loss and depression along with costs associated with nursing home and/or home care.

The provision of prosthetic services should be viewed as restorative. Other states have found that curtailing or eliminating these vital services have actually cost them more money in the long run. Not only have prosthetic coverage laws returned people to work and saved money for the states passing it, health insurers’ profits in those states have increased at a rate greater than the Cost Performance Index (CPI) since passage.

"The subsequent cost to the healthcare system far exceeds that of providing prosthetic care, while the lack of productivity places a huge burden on society," said Senator Bonacic.  

Research shows that the cost of providing prosthetics is less than $2.00 per year --- pennies per month. A study produced by the Colorado Department of Health Care Policy and Financing found that the cost of providing prosthetic coverage would be 12 cents per member per month. Analysis conducted by the California Health Benefits Review Program (CHBRP) estimated the cost to be about 16 cents per member per month.

"As a health care professional, I see the impact that current insurance regulations are having on real people here in our state," added Shepard.

That includes people like Carrie Molinari of Roscoe, NY. Carrie has been an ardent advocate for her son, Chase.

"I have fought hard for Chase to get the care he needs every step of the way," said Molinari. "I have had to have him declared disabled in order to secure Medicaid funding. But he is not disabled. He can do what any other little boy can do. He just needs his prosthesis."

"Without this legislation, I worry that Chase will not have the care he needs when he finishes college and enters adulthood. I urge legislators to pass this bill for my son and all of the other children out there who are only asking to be given the chance to lead independent lives."

"This is a young man with a zeal for life who sees his artificial limb as an inconvenience rather than a disability. This legislation would ensure that others like him are treated fairly by insurance companies and are given a chance to succeed in their lives, said Senate sponsor, Senator John Bonacic."

"This is not only smart policy, it is the right thing to do," said Adam Lawlor, a local amputee who continues to fight restrictive insurance regulations to access appropriate prosthetic care.

Other co-sponsors in attendance mentioned that they too see a need to change the law so that there is more uniformity in regard to prosthetic coverage. Currently, prosthetic care is covered by Medicare, Medicaid, most state Children’s Health Insurance Programs, the VA, Workmen’s Compensation and state funded vocational rehabilitation programs. To date, six states have already passed similar legislation and at least 23 others are working toward the same end.

"Our goal is to allow amputees to live their lives to the fullest, whether it is earning a living for themselves and their families or experiencing the everyday joys of life that are so often taken for granted," added Gunther.

Activists hope that the momentum created by today’s rally will help them advance this important legislation.

   Check out the press coverage!  To get involved, contact us at APPLL@amputee-coalition.org.