Even if patients lack insurance to cover costs, prosthetic makers' coalition vows to help them walk again
TUESDAY, April 30, 2013 (HealthDay News) -- A coalition of manufacturers has pledged to provide new prosthetic legs for victims of the Boston Marathon bombings if their health insurance won't cover the full cost of the devices.
Prosthetic limbs are prescribed by doctors and have to be fitted to suit an amputee's activity level and needs.
The price tag for an artificial leg for a below-the-knee amputee can run from $8,000 to $12,000, while the cost of a prosthetic to replace a leg lost above the knee can run between $40,000 and $60,000.
Dr. David Crandell, director of the amputee program at Spaulding Rehabilitation Hospital in Boston, is treating 16 patients who were injured in the Boston attacks, including eight amputees. He said two of those patients lost both legs. Four patients lost a leg below the knee, and two more lost a leg above the knee.
It's not clear whether the patients have enough insurance to fully cover the cost of new prosthetics, but the prosthetic manufacturers said they wanted patients to know that their devices would be covered if they needed financial help.
"We want to ensure that in the midst of this horrific tragedy, these individuals are not further traumatized by the harsh and unreasonable limits that are present in all too many health insurance policies today in the United States. As an industry, we would not want to see these people victimized twice," said Tom Fise, executive director of the American Orthotic & Prosthetic Association, who spoke at a news conference Tuesday to announce the initiative.
Two weeks ago, two bombs exploded near the finish line of the Boston Marathon, killing three people and injuring more than 260 others. Some of the most seriously wounded victims lost one or both legs in the blast.
Insurance coverage for prosthetics varies widely. While government plans like Medicare and the VA generally provide full coverage for new prosthetics and the rehabilitation needed to use them, private plans sometimes have very low coverage limits that put the latest technology out of reach.
"Common coverage limits we see are annual caps of $1,000, $2500 or $5,000," for prosthetic devices, which are often covered as durable medical equipment, said Dan Ignaszewski, director of government relations for the nonprofit Amputee Coalition.
Coverage limits may help patients get braces, crutches or limbs, but they don't touch the cost of newer devices which are now powered by microprocessors and made with sleek materials.
"As the devices have become higher functioning and more expensive, insurance coverage hasn't kept up," Ignaszewski explained.
Also, policies may limit coverage to a single prosthetic limb over the course of a lifetime. Lifetime limits are especially hard on children, who quickly outgrow their devices.
If patients don't have insurance or their plan doesn't fully cover the costs, the coalition has pledged to provide the first prosthetic leg for Boston victims. They just need a letter from their doctor attesting to the fact that they were hurt in the Boston attacks and describing the kind of device they need.
"There's no reason why every American amputee shouldn't be fully functional, except that some health insurance isn't willing to pay for it," said Kendra Calhoun, president of the Amputee Coalition.
While Calhoun said she was glad to see companies stepping in to help victims of the Boston attacks, she urged people not to forget the estimated 500 people who undergo amputation each day in the United States.
"Arms and legs are not luxuries," Calhoun said. "Medically necessary prosthetic devices should have the same insurance coverage as implantable devices like hips and pacemaker."
The U.S. Department of Defense and the VA recently completed a study that found five-year prosthetic costs to be as high as $450,000 for a patient with multiple limb amputations, $230,000 for a person with a lower-limb amputation and $117,000 for a person with an upper-limb amputation. Studies estimate that the lifetime health care costs for a person with limb loss can exceed $500,000, according to background information provided by the coalition.
For more about insurance coverage for prosthetic limbs, visit The Amputee Coalition ( http://www.amputee-coalition.org/limb-loss-resource-center/resources-by-topic/financial-assistance/index.html ).
SOURCES: April 30, 2013, news conference with: David Crandell, M.D., director, amputee program, Spaulding Rehabilitation Hospital, Boston; Dan Ignaszewski, director,government relations, Amputee Coalition; Tom Fise, executive director, American Orthotic & Prosthetic Association; Kendra Calhoun, president, Amputee Coalition