I am amazed at the number of working individuals who are denied access to prosthetic care.  I realize that healthcare benefits, in general, can be very poor for working and non-working people.  There are people in this country who cannot afford the very medicine that may be keeping them alive. 

Having said this, I think that people really underestimate the results of limiting prosthetic coverage, particularly for amputees who are in the work force.

Many group insurance plans, be it PPO or HMO, set unrealistic limitations for prosthetic coverage.  Examples of prosthetic limitations are:

Only one prosthesis covered every three years

An unrealistic yearly benefit limit amount, such as $2500.00

A lifetime limit for prosthetic benefits

Replacement only covered due to anatomical growth, not wear and tear

There are other limitations, such as categorizing a component as non-covered or experiment.  This is common with microprocessor prosthetic components. 
 

On top of these coverage limitations, many amputees face extremely large deductibles and/or co-insurances for prosthetic care. 

Imagine Yourself Here:

So, imagine you are a teacher and you use a prosthetic leg.  One day, your prosthesis breaks and that's when you realize that your insurance company will only cover $2,500.00 for replacement.  That's not even enough to replace your foot alone.  You're no paralympic athlete, but you're on your feet a lot as a teacher.  You also have small children at home.  Your family has its head above water financially, but you're almost living month to month with a little in savings.  Your cards are at the maximum and credit lending is too tight right now to get an increase.  You get a referral to Vocational Rehabilitation to see if they will help fund a new prosthesis for you, but you have been put on a waiting list for services.  On top of everything, your house in not wheelchair accessible.

If you're not able to make that transition to a wheelchair seamlessly, you may be left wondering how you will keep your job and take care of your kids.

So what is your option?  Well, if you're unemployed, you may be eligible for government benefits.  So you surprisingly find yourself in a position you never thought you'd be in... accepting government money.

Unemployment Hurts Everyone

If we as a society want to reduce unemployment and increase the size and quality of our work force, we need to make sure that working people have access to the necessary medical care.  To ensure this prosthetic coverage, the general public would see their premiums go up each month... by a few cents.  That's cheap compared to tax dollars spent to support the unemployed. 

Fight For Change

Visit www.amputee-coalition.org and learn more about the proposed Federal Prosthetic Act (HR 5615).  360 O&P also features an article on our site that goes into details about what the act proposes and why it's so important.