I got a call last week from Joey, a technician who used to work for me. He asked if I could work on his microprocessor-controlled knee. Between the manufacturer and me, we had been able to keep Joey's heavily used knee in the saddle for about five years. I had told him before he moved back up north last year that he really needed to be thinking about replacing that knee. I had to ask him why he would want to spend good money on a worn-out knee when what he needed was a new one. Joey started out by saying, "Remember you told me to make sure whoever I went to work for had good insurance that would pay for prosthetics?" I told him I did remember and that I hoped he had taken my advice. He said he had asked about prosthetics coverage and was told that he would have great health insurance with O&P compensation. His new employer said he had made sure they had it before he renewed their policy last year. Joey told me he worked there for about a year and then his knee started acting up. He went to see his doctor and got all the right forms filled out for a new knee. His company sent the forms to the insurance company for authorization, and then Joey and the prosthetist he worked for started comparing the knees he might want to try. He said about a week later the insurance company called to say their company's policy will only pay up to $6,000 for a new leg. As soon as he got off the phone with the insurance company, he called the owner of the company to find out why they have a $6,000 limit on their O&P coverage. The company owner was really embarrassed when he found out that he had in fact not read the fine print and had agreed to a $6,000 limit on durable medical equipment (DME), under which the insurance company lumped both O&P. The company owner is an advocate of parity and was even working with other professionals in the state to get a parity law passed. It was simply overlooked and there was nothing that could be done until the policy came up for renewal in a few months. In the meantime, I'll see if I can patch Joey's knee up one more time and hope it lasts longer than his current coverage does. I know I've talked about parity before, but this is a story worth telling over and over until everyone gets it right. With a bunch of politicians passing a law one year that would end exclusions for O&P and another bunch of them taking away the funding for the law the next, I doubt this will ever get fixed by politicians. Right now only 19 states have laws to stop this kind of discrimination. That's what it is—discrimination. Think about it: What if insurers decided to start singling out other conditions like diabetes or heart disease? The treatment of heart disease is surgery and medication. The treatment for limb loss or loss of function is a prosthesis or an orthosis. Take away treatment and you take away the hope of recovery. Parity is as simple as shrimp and grits. Insurance companies need to control cost, and some insurers think limiting access to prosthetic and orthotic devices is a good way to control that cost. We just need to let them know it isn't. Studies have shown that prosthetic coverage would add less than 60 cents to the average individual monthly premium and in some studies, providing prosthetics actually reduced future healthcare costs. The bottom line is that parity, like charity, begins at home. That means letting insurance companies know that choosing to treat O&P coverage like a luxury option on insurance policies is the wrong choice. When I have to keep patching up worn out legs and hearing stories like this it's no wonder I'm still...Edgy. Editors note: Edgy, as you might guess, is an amputee who works in the O&P profession. You can e-mail your own edgy comments and stories to linkEmail('OandPedgy','aol.com');
