Amputees face tens of thousands in out-of-pocket costs for replacement limbs

Amputees across the U.S. are facing increasing costs for prosthetic limbs and rehabilitation services due to insurance coverage limits, according to The Associated Press, and little help is on the horizon from the Affordable Care Act.

Heather Abbott, who lost a foot due to injuries sustained in the Boston Marathon bombing, told the AP that she was fortunate: "[My insurance company] told me most of the costs are covered for one limb, but they're considered on a case-by-case basis," she said. Several charities are pitching in to help with some of the victims' other expenses, but they cannot cover everything -- and that's just for a small set of amputees compared to the national picture.

The Amputee Coalition says that financial barriers to prosthetic limbs are a number one concern among its members, who face paying $5,000-$10,000 or more for limbs in the wake of an injury or disease. Some limbs can cost up to $50,000, and the added costs of rehab are often too much to bear.

One of the primary stumbling blocks for many amputees are their private health insurance policies, many of which provide no more than $5,000 in annual coverage for medical hardware like prosthetic limbs. Meanwhile, many amputees can expect medical bills that grow up to $450,000, the director of the American Orthotic and Prosthetic Association (AOPA) told Reuters.

The Affordable Care Act attempts to address this by requiring private insurance policies to cover essential health benefits like rehabilitative and habitative services and prosthetic limbs, but it does this by giving states the option of including enhanced coverage in their benefits packages.

According to Politico, so far 20 states have included some kind of ban on prosthetic coverage caps in their essential health benefits, but just nine pay rates matching Medicare and none cover replacement limbs within a 3-5 year period.

That adds up to tens of thousands of amputees across the country who still face seemingly insurmountable costs in the years ahead, unless Congress enacts legislation offering them greater and more uniform assistance.

"If these patients are prevented from accessing the care needed to continue to be productive members of society, they are often forced to become reliant on public programs such as Medicaid," the AOPA said in a letter (PDF) endorsing The Insurance Fairness for Amputees Act. "In addition, complications such as flexion contractures, skin breakdown, osteoporosis, muscle loss, depression, and costs for nursing home or home care can all far exceed the costs of providing orthotic and prosthetic care to patients."

The Amputee Coalition explained (PDF) that the bill would "require that if an insurer covers prosthetic devices, they must cover them on terms no less favorable than other benefits within the policy. This would mean that caps and restrictions would no longer be applicable to prosthetic devices and would ensure coverage is similar to other medical and surgical benefits in their policy."

This video is from The Associated Press, published Tuesday, July 23, 2013.

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["Stock Photo: Disabled Man With Prosthetic Leg, Practicing Nordic Walking" on Shutterstock.]