Tom Walsh, Amputees Meets State Representative to Discuss Amputee Insurance Protection Legislation
August 22nd, State Representative James Raussen, (R – Springdale) visited Abilities In Motion’s White Oak office to discuss insurance protection. Prosthetic insurance protection is a subject close to Tom’s heart. Tom is a leading figure in the drive to have Ohio State legislature pass a bill that would require ALL coverage of prosthetics to be equivalent to that of Medicare guidelines.
In recent years we have seen an increase in the number of healthcare plans that cap the funding for prosthetic devices. Some of theses caps are annual, some are for lifetime.
For example, some insurance companies have recently begun lifetime prosthetic benefit caps of $2,500 or have limited patients to one prosthesis per lifetime. Other insurers have annual caps as low as $500.
The effects of these caps can be devastating for patients trying to maintain productive, healthy and active lifestyles. Depending on activity level, health changes to the body and age, a lower limb prosthesis usually needs to be replaced every 2 to 5 years.
Some of the large insurance companies, namely Aetna and Anthem have announced changes starting 2007.
These changes will cap prosthetic devices annually at $2,500 in all states other than California, Colorado, New Hampshire and Maine. These states are exempted from the national prosthetic insurance benefit cuts because amputees and prosthetists already worked together to pass legislation in these states to ensure that insurance benefits include adequate coverage for prosthetics. This is the legislation that Tom is trying to get passed to protect the interests of the amputees of Ohio. Other states, New York, Connecticut, Massachusetts, New Jersey, Washington, Alabama and Louisiana have legislation pending.
Representative Raussen was a keen listener and expressed concern for our issues. He made some suggestions concerning how to achieve greater statewide recognition and recommended Health Saving Accounts (HSA) for those that can afford to save.
Amputees have not had vocal national organized advocacy groups that can lobby for their rights, until the Amputee Coalition of America (ACA) mobilized with a support system for regional efforts to pass legislation.
The Colorado legislation is estimated to add just 14 cents per month to the cost of insurance premiums to adequately cover prosthetics state wide.
Options for the disabled on Medicaid are getting worse. Texas for example, dropped Medicaid coverage of prosthetics completely. Other states such as Missouri are debating similar cuts. This seems foolish as Colorado’s figures have shown. The year after passing a law to insure prosthetic coverage for Medicaid, the state of Colorado saved almost $500,000 through decreased medical expenses. This did not even include the savings of getting people back to work and off Medicaid.
If you are interested in helping the push for legislation in Ohio, give us a call and we can help you with letters to state congressional and senate reps. The more support Tom gets from the amputee community in addition to the effort he is leading with his fellow prosthetists statewide, the greater the chance of change being effected.
Walter Lickliter, 57 had a right below knee amputation in July of 2004. Walter also has a left partial foot amputation. His main goal before surgery was to improve his balance and begin the process of learning to walk again. Within two weeks of being fit with his prosthesis, Walter said “I am encouraged by my progress from wheel chair to walker. I have not had any pain since just after the surgery”. He learned quickly through experimentation how to use socks to obtain a correct fit and does not feel his prosthesis limits him. “I like the comfort of my prosthesis and just being able to walk again”.
Sarah Ammons underwent surgery for a below knee amputation in 2002. Sarah said “I expected to have less pain, as I have a great deal of phantom pain”. She did not expect to be walking unassisted immediately, “I expected a long rehab”. Although undergoing a second surgery earlier this year, she is walking without assistance.
Sam Crosby has a left below knee and a right partial foot amputation. For Sam, a former college quarterback, rehab went very smoothly. “I just expected to be able to walk and I pretty much did. I knew I would be able to walk without crutches”. Sam reported that he never really had any pain and that learning sock fit was easy.
David Fischer became an above knee amputee just a few months ago in May. David says he wasn’t really sure what his expectations were prior to surgery as it happened so quickly. He said of his expectations upon receiving his prosthesis “I didn’t expect I would just get up and walk. I had a pretty good idea about the rehab process”. After initial fitting and physical therapy, David says he was more confident of being able to return to normal mobility. He has suffered from some phantom pain “but I’m managing well”.