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Prosthetic Coverage Legislation: A Tool Kit for State Organizers

Sample Testimony, Practitioner

Good morning, Chairman/woman and members of the committee. My name is [NAME] and I’m a certified prosthetist at [FACILITY NAME], in [ CITY]. I’m here to testify in support of [ BILL #].

Every year, more than 185,000 Americans undergo an amputation. This number does not include our returning veterans who have suffered traumatic injuries and amputations while serving overseas. There are currently almost 1.7 million Americans living with limb loss.

People with limb loss can and do regain their lives as productive members of society. Their inspiring stories serve as a reminder of man’s unyielding spirit. But no amount of drive and determination can restore the natural function of an arm or a leg. These survivors can only regain their lives with the help of rehabilitation and orthotic and prosthetic (O&P) devices.

Insurance companies have begun to limit reimbursement at unrealistic levels. Some have imposed $2,500 or even $1,000 annual maximums on durable medical equipment ( DME), where orthotics and prosthetics have traditionally been categorized. Others have sold policies that state that a covered person is allowed only one prosthetic per lifetime.

People suffering from limb loss are amputees for life. Their legs and arms are not growing back. Imagine if you were fit with a pair of shoes at 5 years old and were told you had to wear that same pair of shoes for the rest of your life. Even at 25 or 55 years old, this expectation of one limb per life is completely absurd.

We all know about the ever-increasing cost of medical care. The average commercial premium is just under $300/month. The average Medicare premium is over $550/month. Of these monthly premiums, less than 53 cents is spent on O&P care. Analysis shows this legislation would have no more than a 2 to 3 cent increase in monthly premiums. Importantly, this analysis excluded the cost of amputees who could no longer be productive members of society; nursing home and home care costs, increases in state Medicaid costs due to complications such as contractures, skin breakdown, osteoporosis, muscle loss and depression.

Currently, six states have passed similar bills, Colorado, Maine, New Hampshire, Rhode Island, Massachusetts and California. Five other states introduced bills in the 2006 legislative session, and a number of states have bills at some point in the legislative process right now. There is clearly a national trend toward covering prosthetics, not only because it’s the right thing to do, but because it makes sense for the bottom line.

Your constituents deserve coverage for O&P care that will allow them to regain mobility, maintain dignity and live as productive members of society. Adequate O&P care is critical to functionality and we need legislation that recognizes this. Put O&P devices where they belong – on par with other critical medical services in health insurance plans.

Thank you for your time today.

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