Amputee urges insurance coverage for prosthetics

Legislation that would mandate insurance companies to place prosthetics on par with hip replacements and other internal limb replacement procedures was reviewed but received no official action by the Legislature's special task force on health care reform.

A bill that would have required coverage passed the House during the general session of the Legislature earlier this year but failed in the Senate.

Tami Stanley, an amputee and chief advocate for the legislation, told task force members that "for no reason I can think of," exterior limbs are treated differently than replacement surgeries inside the body.

Stanley, who lives in Orem, made the same argument in February and made it again last month in Washington, D.C., where she urged members of Congress overseeing health care reform legislation to include language that would require coverage. Doing so would help people deal with the catastrophic loss of a limb as well as the overwhelming cost of acquiring artificial arms and legs.

Not doing so just continues a disparity in the medical system of treating people who lose a limb differently than those whose joints have worn out or become arthritic and are replaced under most private and public insurance plans.

Stanley said the number of amputees in Utah is small — about 12,500 — and they have so little clout that the bill stalled on the floor of the Senate. Doing the right thing regarding amputees would not overly burden the medical care system and insurance companies, but it would relieve a huge burden on people who have an accident and wake up to find a limb removed but no coverage for a prosthetic that would help them get their lives back.

Task force member Rep. David Litvack, D-Salt Lake, said because there are so few people who will ever face the problem, mandating that insurance coverage prosthetic devices is the only way people can be assured to have access to coverage in the unlikely event that they need it. In states that have implemented similar legislation, the annual premium increase was $2 per member. Hip or knee replacement in Utah runs $40,000 to $60,000.

About five years ago, Stanley was hurt playing softball and underwent surgery.

"I was devastated when I found out that my insurance would pay almost $1 million to save my leg then to remove it, but not provide any coverage whatsoever to replace it," she said, adding the cost of the prosthetic lower leg was about $12,000.

"Assistive devices such as prostheses are essential items to ensure that people, like me, with limb loss contribute to society instead of being dependent on it," Stanley said.

e-mail: jthalman@desnews.com