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In a lighter moment during a House panel hearing, Lt. Col. Andrew Lourake shows off his prosthetic leg. To his right are Lorenzo Smith, who lost a leg when he was hit by a car, and his mother, Albertha Jackson-Smith. (By Katherine Frey -- The Washington Post)

To Promote Bills, Amputees Describe Insurance Travails
By Philip Rucker, Washington Post
Thursday, February 14, 2008; B06

Lorenzo Smith was hanging out with friends in his Suitland neighborhood after school one afternoon about two years ago. That's when the speeding car struck.

Sixteen operations later, doctors amputated Smith's right leg from the knee down. He figured he would get a prosthetic leg, and things would be close to normal.

But it was not that easy, as Smith, 15, and his mother told a panel of Maryland legislators yesterday.

"I will never forget the extreme dismay my child suffered when I told him the leg was not an option for us," said his mother, Albertha Jackson-Smith.

Smith was one of several amputees who testified yesterday before the Maryland General Assembly, telling the House Health and Government Operations Committee in sometimes gripping detail that their medical insurance companies would not pay the full costs of their prosthetic limbs.

The amputees pleaded with legislators to join other states in supporting the Prosthetic Parity Act, which would require insurers to cover prosthetic devices.

Many private companies restrict or preclude coverage of prosthetic limbs, but Medicaid, Medicare and state nonprofit health insurance plans cover all such devices without restrictions.

Jackson-Smith told lawmakers she learned that her son's insurance company would pay for only half of the cost of his leg. The microprocessing knee that would give Smith a normal gait and greater agility would cost thousands more.

"These legs cost about $40,000," Smith told lawmakers. "It's like buying a brand new Mercedes-Benz."

So his mother raised money from neighbors and friends to pay the other half. She hosted a walk-a-thon and a gala fundraising dinner and established the Lorenzo Smith Fund.

Del. Heather R. Mizeur (D-Montgomery), who introduced the legislation, said that many amputees cannot afford prosthetic limbs unless their insurance companies cover the full costs.

"Maryland families should never again have to suffer the indignity of holding a bake sale or car wash to pay for a prosthetic device," Mizeur said.

Frank Jennings Jr., whose leg was amputated last year because of diabetes-related complications, said that he does not have a prosthetic leg because his insurance company will not pay for it.

"When they denied me, I was really outraged, and also I was sad, disappointed, and I felt like they weren't giving me the services I deserved after paying premiums for all these years," said Jennings, 62, of Baltimore.

Without a prosthetic leg, Jennings said, "I'm no longer working, and neither can I do the chores I enjoyed doing all over the house. All I can do is use the walker to go from the living room to the kitchen and to the bathroom."

No insurance industry representatives testified at the hearing.

Morgan Sheets, national advocacy director for the Amputee Coalition of America, told lawmakers that the lack of private insurance coverage for prosthetics is creating hardships across the state.

"In many ways, we are simply asking to close that loophole," she said.

Eight states have passed prosthetic parity legislation, and more than 30 are considering it, said Sen. Catherine E. Pugh (D-Baltimore), who has introduced a Prosthetic Parity Act in the Senate.

"Americans with limb loss can and do live successful, productive lives, but they need appropriate prosthetic care," Pugh said.

Referring to Smith's case, she said, "Thousands of Maryland amputees will face the same fate as Lorenzo unless we do what is right: Put prosthetic devices on a par with other critical medical services."

One amputee described a relatively positive experience with prosthetics. Lt. Col. Andrew Lourake, a pilot at Andrews Air Force Base, said that after his leg was amputated, the military paid for his prosthetic leg so he could return to active duty as a pilot.

Lourake sought to inject some humor into an otherwise emotional hearing by removing his prosthetic leg and holding it upside down. He and the legislators laughed.

Returning to his testimony, Lourake said, "The federal government and the military saw that I was worth keeping."

"I wanted my life back, and the way I was able to do that was with the newer, quality prosthetic."