Utah Legislature: Bill would require insurers to cover prosthetics

SALT LAKE CITY — Tami Stanley realizes if she hadn't been playing softball that day five years ago, and if she hadn't slid into third base at just the right angle and with enough force to shatter her shin bone, she would still have both legs and a lot fewer dealings with hospitals, insurance companies and a generally recalcitrant group of state lawmakers.

"It was just one of those things," Stanley said Monday, taking a break outside the Senate chamber where, for the third time in three years, her efforts to get insurance companies to cover prosthetic limbs is in limbo. "Accidents happen, playing softball or driving the daily commute. Life is a risk."

Stanley has turned the injury into the motivation behind her one-woman lobbying campaign to make man-made limbs a covered benefit and on par with coverage offered by private insurers for man-made joints.

"The only difference is one is visible and the other isn't," she said prior to a doctor's appointment to adjust the fit of the metal device that is her lower right leg. The accident, the surgeries to save the leg, the infections that complicated everything and even the amputation were covered by her insurance plan. But spending another $18,000 for a prosthesis was refused.

"I couldn't believe it," Stanley said of a long list of the unique ways she believes insurers and the health care system defy both financial and common sense. She managed to work around the system herself, but believes no one who has lost a limb should have to deal with added hassle of insurers' arbitrary exclusion of amputees.

"They'll pay almost any amount to try to save someone's limb, but pay almost nothing to help with the one thing that will get their life back," Stanley said. "It's the way health care works too often — a lot of procedures and surgeries that too often don't really add up to a lot of health care."

Lawmakers over the past three years have given Stanley plenty of excuses and not many reasons for balking at parity of prosthetics.

"They tell me they agree it's the right thing to do, but they somehow never get around to doing it," she said, noting that this year's parity proposal, HB66 has the best chance ever of passing.

"I don't know what has happened, but I'm being told that this time around, there are enough votes in the Senate," Stanley said. "The fear that the bill would somehow open the floodgates of insurance claims has subsided suddenly for reasons I can't really explain but couldn't be happier about."

Stanley has spent enough time in granite hallways to know that the only thing set in stone on the hill is the Capitol building. And with a Thursday end-of-session deadline looming, momentum to get the measure through when it comes up Tuesday morning is the last best try she'll have, at least this session.

That she has gotten this far is no small achievement, given that the measure is being carried by a Democrat and that the bill contains an M-word — mandate, a word the Republican-dominated Legislature loathes.

Stanley said she is doing her best to stay out of that fight by focusing on her own M-word — merits.

"Mandate is kind of a dirty word around here," she said, "but this is about the merits of ultimately doing what's right for Utah amputees."

e-mail: jthalman@desnews.com