Each year approximately 185,000 people in the United States will suffer some form of ampuation. Currently, there are at least 2 million people nationally with some for of limb loss. This means that there is a high probability that someone you know will have or has had an amputation. With the ever rising number of amputees there continues to be a large population that is unable to receive a prosthetic device that would better their lives. Most health insurance companies lump prosthetic devices into the same category as bed side commodes and crutches, leaving the amputee to cover the ever increasing cost of the prosthetic limb that would change their lives. With proper access to an appropriate prosthetic and prosthetist many amputees are able to return to a quality of life that is comparable to the lives they were leading prior to amputation. This is evident with the number of service members able to return to active duty despite limb loss. 

By providing Insurance Fairness nationally, insurance companies would have to cover the prosthetic device prescribed by a physician; so long as it meets the activity level of the amputee. This coverage will not only benefit the number of amputees that are currently without prosthetic coverage by affording them a prosthetic device that will better the quality of life they are leading, it also saves the insurance companies money in the long run by cutting down on the increase of secondary illness that are a result of a sedentary lifestyle (hypertension, heart disease, obesity, etc...). 

Currently, there are 20 states nationally that have some form of Insurance Fairness Laws. We hope to have a national law passed that will provide for the numerous amputees that are currently suffering due to a lack of availabilty. 

No longer should an insurance company, not a physician, dictate the best prosthetic device for an individual. With the ever advancing technology in prosthetic devices, amputees are able to lead a promising and functional life post amputation. 

Please sign the petition and help move this cause forward. 

 

Here is a sample of an Insurance Fairness bill drafted by the Amputee Coalition of America.

 

Insurance Fairness for Amputees: Model Bill Language 

All individual and group health insurance policies providing coverage for hospital, medical or surgical expenses shall 

provide coverage for benefits for prosthetics and orthotics that are at least equivalent to that currently provided by 

the federal Medicare program, and no less favorable than the terms and conditions for the medical and surgical 

benefits in the policy. 

 

(a) 'Orthotic device' means a rigid or semirigid device supporting a weak or deformed leg, foot, arm, hand, back or 

neck, or restricting or eliminating motion in a diseased or injured leg, foot, arm, hand, back or neck. 

 

(b) 'Prosthetic device' means an artificial limb device or appliance designed to replace in whole or in part an arm or 

a leg. 

 

The policy shall cover the most appropriate device that is determined to be medically necessary by the treating 

physician to restore functionality to optimal levels. The coverage required includes all services and supplies 

necessary for the effective use of a prosthetic or orthotic device, including formulating its design, fabrication, 

material and component selection, measurements, fittings, static and dynamic alignments, and instructing the 

patient in the use of the device. This includes all materials and components necessary to use the device. 

 

The reimbursement rate for prosthetic and orthotic devices in all health plans must be at least equivalent to that 

currently provided by the federal Medicare program and no more restrictive than other benefits in the policy and 

shall be comparable to coverage of restorative internal devices without arbitrary caps or lifetime restrictions. 

 

The coverage required shall include any repair or replacement of a prosthetic or orthotic device that is determined 

medically necessary to restore or maintain the ability to complete activities of daily living or essential job-related 

activities and that is not solely for comfort or convenience. 

 

Prosthetic and orthotic benefits may not be subject to separate financial requirements that are applicable only with 

respect to such benefits. A health benefit plan may impose copayment and/or coinsurance amounts on prosthetics 

however any financial requirements applicable to such benefits may be no more restrictive than the financial 

requirements applicable to the plan’s medical and surgical benefits, including those for internal devices. 

 

A health plan may limit the benefits for or alter the financial requirements for out of network coverage of prosthetic 

and orthotic devices, however the restrictions and requirements applicable to such benefits may be no more 

restrictive than the financial requirements applicable to the out of network coverage for the plan’s medical and 

surgical benefits. 

 

The requirements of this section shall apply separately with respect to benefits provided under the plan (or 

coverage) on an in-network basis and benefits provided under the plan (or coverage) on an out-of-network basis. 

 

A health benefit plan shall not impose any annual or lifetime dollar maximum on coverage for prosthetics other 

than an annual or lifetime dollar maximum that applies in the aggregate to all terms and services covered under 

the policy. 

 

If coverage is provided through a managed care plan, the insured shall have access to medically necessary clinical 

care and to prosthetic and orthotic devices and technology from not less than two distinct [INSERT STATE] 

prosthetic and orthotic providers in the managed care plan's provider network.