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Amputees Fight To Make Insurers Raise Prosthetics Coverage

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The Associated Press

Published: June 10, 2008

SOUTH BURLINGTON, Vt. - After bone cancer forced the amputation of her right leg below the knee, Eileen Casey got even more bad news: Her insurer told her that she had spent her $10,000 lifetime coverage limit on her temporary limb and that the company wouldn't pay for a permanent one.

"It was shocking to find out I was going to have to take out a loan to buy myself a leg so I could keep working and living independently," Casey said.

Since then, Casey has joined a nationwide fight by amputees and the prosthetics industry to get states and Congress to require better coverage for artificial limbs. The insurance industry is fighting the effort, saying such mandates drive up costs and limit the flexibility customers want.

Simple prosthetic limbs range in cost from about $3,000 to $15,000. Those that are more mechanically advanced, or come with embedded computer chips, can cost up to $40,000. Expenses can grow further because many patients need new artificial limbs or sockets when the stump to which the prosthetic arm or leg is attached shrinks or otherwise changes shape. This is especially common for children.

Medicare, the government health insurance program for the elderly, covers 80 percent of prosthetic costs and, unlike many private insurers, does not consider the more expensive mechanical or computerized limbs experimental.

The Veterans Affairs Department provides prosthetic care without limits, said VA spokesman Terry Jemison. Anyone eligible for VA benefits - from a young soldier wounded in combat to an older veteran who has developed diabetes late in life - "will receive the latest in technology without limits on cost," Jemison said.

Paddy Rossbach, president and chief executive of the Amputee Coalition of America, said the health insurance industry's talk of mandates driving up costs is overblown.

She said studies in six states that have passed these laws showed that increased coverage for prosthetics had added 12 to 25 cents a month to the average insurance premium.

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