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Amputees in Virginia today are facing the grim reality that a growing number of group and private insurance companies are imposing unrealistic caps on prosthetic coverage or are eliminating coverage altogether. Typical annual cap amounts are in the $1,500 to $2,500 dollar range. With the cost of a below-knee (BK) prosthesis ranging from $6,000 to $12,000, these caps are absurdly low. Considering that BK devices are the least expensive, above knee and upper extremity amputees are at even greater financial risk.

I would strongly suggest that you verify your policy’s prosthetic coverage if you are not already aware of it. And do not think you are safe just because your policy does not have an annual cap or some other restriction now. This trend to limit prosthetic coverage has already spread thru more than 40 percent of policyholders polled and is obviously growing in popularity among the insurance companies. Every policy that insurers can cap just adds more dollars to their bottom line.

By depriving amputees of the prosthetics they need to regain their lives, insurance companies are impacting not only amputees and their families, but also every working Virginian. First, lack of proper prosthetic care prohibits an amputee from regaining their life. This may be a student who cannot negotiate their way around campus, or a worker who can no longer perform their job and support their family. This of course, in turn, impacts their families and or caregivers.

Secondly, when some amputees cannot get adequate coverage from their insurance company, they are left with no other choice than to seek public assistance to help with the cost of the prosthesis and any necessary rehabilitation. As a result, every taxpayer is picking up this cost, a cost that the insurance companies have already collected premiums to cover.

Senate Bill 645

This Bill (SB645) was introduced because we must prevent the private insurance companies from neglecting their clients who have been paying health insurance premiums while assuming that they were covered for any catastrophic injury or illness. This will also prevent insurance companies from shifting their financial obligations on to the taxpayers of Virginia by reducing their prosthetics coverage to levels that will not begin to cover the expense.  It is reprehensible that these insurance companies be allowed to treat the loss of a limb as anything less catastrophic than a heart attack or cancer surgery.

In response to this alarming benefit-cutting by insurance companies, Senator Patricia Ticer, of Alexandria, Va., took up the fight to defend the amputees of Virginia who, until this point, had no one to champion their cause. Senator Ticer and her staff, especially Peggy Papp, have worked tirelessly to lend us any help possible in seeing this Bill move forward.  The Bill was introduced during last year’s General Assembly session and was referred to the Special Advisory Commission on Mandated Health Insurance Benefits.

The Bill’s Progression & Defeat

As part of the research and information gathering for the Commission members, a report was prepared by the Joint Legislative Audit and Review Commission. That report, which was considered very favorable, stated time and time again that this legislation would have a minimal impact on insurance premiums, was consistent with the role of insurance, and in all probability would reduce health care costs to both the State and the private insurance sector. It also stated that this mandate was one of the lowest in costs of all mandates. The report stated that the insurance companies would probably experience a small administrative cost to monitor the Medicare program that SB645 proposed to use as a standard. However, keep in mind when reading this report that the majority of this administrative cost has now been negated by the fact that the tie to Medicare was removed at the request of the insurance lobbyists. How can our legislators ignore an exhaustive study and review that they commissioned at great expense to the taxpayers of Virginia? Senator T. Norment, chairman of the JLARC Commission, would not meet with us when we were in Richmond to discuss the merits of SB645. He chose instead to side with the insurance industry, ignore the facts from his own commission and join in a partisan effort to vote against SB645. You can read and download this report at http://jlarc.state.va.us.

The Commission held public testimony on September 20, 2007. During this hearing, over 100 supporters attended and 30 people testified in support of the bill. The meeting took the entire afternoon’s session due to the large number of people testifying and the amount of discussion and questions by Commission members to medical experts that were there in support. A vote was scheduled for the October Commission meeting.

The Commission met again on October 15 to vote but failed to reach a quorum. In spite of this, Chairman Ware held an informal vote where the bill was passed. They rescheduled another vote for November 29. At the November 29 meeting a quorum was reached, a vote held and the bill was officially passed by a vote of 6-4 with the Commission stating that the benefits of the proposal compare favorably to the cost of providing the coverage, and the bill should therefore be enacted.

When the current General Assembly session started in January of 2008, Sen. John Edwards joined in our fight by proposing a like bill numbered SB13. This show of support by such a dedicated and respected statesman was of great help. The bills were referred to Commerce and Labor where SB13 was incorporated into SB645 and was Reported (14-Y 1-N). It was then referred to Finance due to an amendment to include State Employees that was attached while in Commerce and Labor. Prior to being heard in Finance, the Dept. of Planning and Budget prepared a Fiscal Impact Statement which stated that there would be zero fiscal impact to the State due to the fact that State Employees already have the same level of coverage that is being sought by SB645. At this point, it was reported from Finance (9Y – 6N – 1A) and sent to the floor where it was blocked, by re-referring it without apparent cause, back to Commerce and Labor.

One of the reasons that were used to justify routing the Bill around through Finance and then back to Commerce and Labor was the fact that it had been modified from its original state. These changes were minor concessions we made at the request of the Insurance lobbyists during a meeting that was held at the request of Sen. Ticer to try and negotiate a mutually agreeable Bill. The lobbyists told us that if we would make these modifications, though they would not publicly support the Bill, they would not oppose it. But when their turn came to speak during the Comm erce and Labor hearing two hours later, they openly opposed the bill and raised the issue that it had been changed without once admitting that they were the ones who had made the request to change certain items. They insinuated that these changes might make the bill more costly, knowing that this was untrue and that the Bill would actually cost less.

Looking Toward 2009

As frustrating as it was not to get the Bill thru the Senate and over to the House, having it re-referred is better than having it be voted down on the Senate floor. If it had been voted down then we would have to start all over again next year. But by being referred back to Commerce and Labor, we will start out next year where we left off this year.

In actuality, considering some of the letters I have read from legislators in the last week and realizing how much incorrect information they quote, we may not have been ready for a vote. Reading these letters I can only assume that they are grossly uninformed due to a lack of initiative on their part, or they have chosen to listen to the disinformation being spread by the insurance lobbies. Make no mistake, the insurance lobbyists seem to have no ethics when it comes to what they state as fact or how they negotiate with us “in good faith.” They are hired mercenaries who are paid enormous amounts to prevent this Bill from ever seeing the light of day, at any cost. They are a despicable element of the legislative process and we as citizens will see very little legislation move on its own true merit until we rid our political system of the special interest groups. But let’s move on before I tell you how I really feel about them.

Let us not dwell on the lost battle, but concentrate instead on our campaign to win the war. We now have a fighting chance to see fair and equitable prosthetic coverage in Virginia. We have advanced the Bill through the Mandated Insurance Commission, a triumph that few mandates enjoy. In the last four years, 22 mandates have been referred to the Commission, ours is one of only three that have emerged victorious.

We can win this war, but it will require everyone to put forth an effort. I know that many of you have already sacrificed much of your time and energy, and I cannot thank you enough. But I must ask you once again to muster your energy and help educate your legislators. If they all hear from us between now and next year there is little they will be able to do but vote with us, because the facts are in our favor. Our job is to be sure they realize the insurance companies are misleading them. If they still want to side with the Insurance Industry in order to keep receiving their campaign money, let them know you won’t stand for it.