If you are a citizen of Connecticut go here to get what you need to contact your state legislators. Ask them to override the Governor Rell's veto of HB 5021. Write your governor and ask her to reconsider. Your health and independence are at stake.
Honestly - how incredibly short sighted. Here we have states in dire financial straights, dependent on income tax and yet the governor vetoes a bill that keeps people working, independent and off state Medicaid.
The clock is ticking - turn the tide in your state! One little voice in Kansas is rooting for you!
Monday, July 6, 2009
Friday, June 26, 2009
Virginia Governor Signs Parity Bill and Personal Update
This just in from the Amputee Coalition of America:
Richmond, VA, June 17, 2009 – A Virginia bill designed to ensure fair insurance coverage for artificial arms and legs was signed into law by Governor Tim Kaine Tuesday.
The bill, known as the Prosthetic Parity Act, requires insurers that cover prosthetic care to provide meaningful coverage for prosthetic devices and better care for people with limb loss by creating a consistent standard for prosthetic benefits. This removes special caps and exemptions placed on prosthetic and orthopedic care that made these very basic services cost prohibitive for many individuals. Because of its potential to help people with limb loss keep their jobs, take care of their families, and live healthy, active lives, the bill was strongly supported by the Amputee Coalition of America, the premier nonprofit organization working on behalf of people with limb loss.
“Unfortunately, many amputees have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to simply work and live,” explained Kendra Calhoun, president and CEO of the Amputee Coalition. “People pay their monthly health insurance premiums and expect their coverage to take care of catastrophic situations like losing a limb. This is the very reason people purchase health insurance.”
Senate Bill 1116 was introduced by Senator Patricia Ticer (D) with delegates John O’Bannon (D) and Lee Ware (R) sponsoring in the House. It was passed in the Senate by a vote of 33-7 on February 3. It was then passed in the House unanimously, 99-0, on February 24. Sponsorship of the bills was bipartisan.
When Susan Bailey became infected with E. coli bacteria that ultimately resulted in the amputation of both her legs above the knee in 2007 at the age of 23, Virginia didn’t have a law ensuring that she would receive meaningful prosthetic care. Because no law was in place, she ran into problems with her insurance company when she wasn’t able to get the prosthetic legs her doctor recommended. As a mother of two, Susan was given above the knee prostheses that didn’t allow her to walk up and down stairs, let alone keep up with her children. Susan had been paying her insurance premiums and expected to be covered adequately to allow her to get her mobility back.
“Thanks to the leadership of the Virginia General Assembly and Governor Kaine, people with limb loss in Virginia can now get the care they need to get back to work and live independent, productive lives,” said Morgan Sheets, the national advocacy director for the Amputee Coalition. “Spread across the insurance pool, the cost of prosthetic care is less than a dollar per month. Because of the lack of productivity caused by inadequate prosthetic care, the cost to the healthcare system in the long run of not providing prosthetic care far exceeds that of providing it.”
**************
True, true. What does one do in the face of such logic? The right thing or continue to turn a blind eye? If you are a member of the KS Health Care Commission, KHPA or a KS Legislator - you continue to ignore the issue and hope it will go away.
So...a lot of people have been asking how I am since paying half my take home salary in 2008 for medical expenses. I'm financially poorer, physically and mentally richer and immeasurably more savvy about "health-I-could-care-less" insurance.
I got a new socket a few months ago because my residual limb bulked up when I started walking with the C-leg. I'm trying out a new suspension system. When it's good, it's SO good. Quick, responsive - I almost feel like my old BK self. Funny how your confidence soars on these days. I feel strong and invincible. Then there are days that I can't explain - I just can't seem to get the socket right, I lose suspension and am constantly fighting the thing - like a grocery cart with a bad wheel. However, the good days are starting to outnumber the bad and compared to where I was a year ago, it's remarkable. With the new socket and suspension system, I don't lose circulation in my residual limb, don't have the painful muscle cramping and now I can walk all the way across campus and back. It's been nearly two years since the accident. My inability to walk properly that first year thanks to the "basic" prosthetic provided, cost me a lot.
Now I discover that I have significant osteoporosis in my remaining femur from lack of proper weightbearing. The rest of my bones are in great shape, but my right femur is pretty scary looking. Once again, this points out the importance of the C-leg which has been scientifically proven to reduce falls and increase mobility. I will do everything in my power to rehab this bone, since it's the only joint left that's keeping me mobile, on two feet, but imagine where I would be if I were limited to the "basic" prosthesis provided to State Employees? Probably in the hospital with a hip fracture and then to a wheelchair with costly, secondary physical complications. It's crazy making, isn't it?
Richmond, VA, June 17, 2009 – A Virginia bill designed to ensure fair insurance coverage for artificial arms and legs was signed into law by Governor Tim Kaine Tuesday.
The bill, known as the Prosthetic Parity Act, requires insurers that cover prosthetic care to provide meaningful coverage for prosthetic devices and better care for people with limb loss by creating a consistent standard for prosthetic benefits. This removes special caps and exemptions placed on prosthetic and orthopedic care that made these very basic services cost prohibitive for many individuals. Because of its potential to help people with limb loss keep their jobs, take care of their families, and live healthy, active lives, the bill was strongly supported by the Amputee Coalition of America, the premier nonprofit organization working on behalf of people with limb loss.
“Unfortunately, many amputees have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to simply work and live,” explained Kendra Calhoun, president and CEO of the Amputee Coalition. “People pay their monthly health insurance premiums and expect their coverage to take care of catastrophic situations like losing a limb. This is the very reason people purchase health insurance.”
Senate Bill 1116 was introduced by Senator Patricia Ticer (D) with delegates John O’Bannon (D) and Lee Ware (R) sponsoring in the House. It was passed in the Senate by a vote of 33-7 on February 3. It was then passed in the House unanimously, 99-0, on February 24. Sponsorship of the bills was bipartisan.
When Susan Bailey became infected with E. coli bacteria that ultimately resulted in the amputation of both her legs above the knee in 2007 at the age of 23, Virginia didn’t have a law ensuring that she would receive meaningful prosthetic care. Because no law was in place, she ran into problems with her insurance company when she wasn’t able to get the prosthetic legs her doctor recommended. As a mother of two, Susan was given above the knee prostheses that didn’t allow her to walk up and down stairs, let alone keep up with her children. Susan had been paying her insurance premiums and expected to be covered adequately to allow her to get her mobility back.
“Thanks to the leadership of the Virginia General Assembly and Governor Kaine, people with limb loss in Virginia can now get the care they need to get back to work and live independent, productive lives,” said Morgan Sheets, the national advocacy director for the Amputee Coalition. “Spread across the insurance pool, the cost of prosthetic care is less than a dollar per month. Because of the lack of productivity caused by inadequate prosthetic care, the cost to the healthcare system in the long run of not providing prosthetic care far exceeds that of providing it.”
**************
True, true. What does one do in the face of such logic? The right thing or continue to turn a blind eye? If you are a member of the KS Health Care Commission, KHPA or a KS Legislator - you continue to ignore the issue and hope it will go away.
So...a lot of people have been asking how I am since paying half my take home salary in 2008 for medical expenses. I'm financially poorer, physically and mentally richer and immeasurably more savvy about "health-I-could-care-less" insurance.
I got a new socket a few months ago because my residual limb bulked up when I started walking with the C-leg. I'm trying out a new suspension system. When it's good, it's SO good. Quick, responsive - I almost feel like my old BK self. Funny how your confidence soars on these days. I feel strong and invincible. Then there are days that I can't explain - I just can't seem to get the socket right, I lose suspension and am constantly fighting the thing - like a grocery cart with a bad wheel. However, the good days are starting to outnumber the bad and compared to where I was a year ago, it's remarkable. With the new socket and suspension system, I don't lose circulation in my residual limb, don't have the painful muscle cramping and now I can walk all the way across campus and back. It's been nearly two years since the accident. My inability to walk properly that first year thanks to the "basic" prosthetic provided, cost me a lot.
Now I discover that I have significant osteoporosis in my remaining femur from lack of proper weightbearing. The rest of my bones are in great shape, but my right femur is pretty scary looking. Once again, this points out the importance of the C-leg which has been scientifically proven to reduce falls and increase mobility. I will do everything in my power to rehab this bone, since it's the only joint left that's keeping me mobile, on two feet, but imagine where I would be if I were limited to the "basic" prosthesis provided to State Employees? Probably in the hospital with a hip fracture and then to a wheelchair with costly, secondary physical complications. It's crazy making, isn't it?
Tuesday, June 9, 2009
If I were a pony, or an elephant, or a lizard...
If I had watched this video a year ago, like most people I would have thought, "Wow...isn't that something?! It's a miracle how far prosthetics have come!" When I watch it now, I just chuckle and shake my head. First, the C-leg microprocessor technology is over 10 years old. Second, every time the patient says how comfortable he is with the C-leg I cringe! Don't let them hear you say that it's comfortable or worse yet, convenient! Comfort and convenience are exclusions here. Third, I don't know what planet they live on, but the reporter says, "Insurance companies are now covering the cost." 'Eh... no...
I heard about a couple of other cases here that are so outrageous it just makes a person question their sanity. What makes human beings so inspired when they see an animal with a prosthesis, like Molly the Pony or a baby elephant with a prosthesis, yet we deny amputees the dignity of a limb? I've become so jaded after hearing story after story of people who are denied a medically prescribed prosthesis that I envy Molly and Chhouk - they receive better prosthetic care than a lot of people. For example, one story I heard was about a person who lost their leg at the ankle. They received a prosthesis but complications developed and the leg had to be amputated again, this time right below the knee. After recovering from the 2nd amputation, the insurance company denied a new prosthesis because 2 years hadn't passed since receiving the 1st prosthesis! Nevermind the facts - that the 1st prosthesis was designed to fit the part of the leg that was amputated - denied.
Ah, if only we were lizards and could regenerate our limbs.
I heard about a couple of other cases here that are so outrageous it just makes a person question their sanity. What makes human beings so inspired when they see an animal with a prosthesis, like Molly the Pony or a baby elephant with a prosthesis, yet we deny amputees the dignity of a limb? I've become so jaded after hearing story after story of people who are denied a medically prescribed prosthesis that I envy Molly and Chhouk - they receive better prosthetic care than a lot of people. For example, one story I heard was about a person who lost their leg at the ankle. They received a prosthesis but complications developed and the leg had to be amputated again, this time right below the knee. After recovering from the 2nd amputation, the insurance company denied a new prosthesis because 2 years hadn't passed since receiving the 1st prosthesis! Nevermind the facts - that the 1st prosthesis was designed to fit the part of the leg that was amputated - denied.
Ah, if only we were lizards and could regenerate our limbs.
Sunday, May 17, 2009
Waymon Tisdale Remembered
I was deeply saddened to hear the news of the death of Wayman Tisdale. He was a musician, basketball star and amputee with an incredible spirit and generous heart. After his amputation, he set up a foundation to help children and families whose prosthetics were not covered by insurance. He was a bright, shining star - a beautiful example of courage and grace.
Wednesday, May 6, 2009
Show Me MO!
Makes me proud to live in Missouri! MO is the 6th state to pass prosthetic parity legislation since the beginning of the year. Read about it here! Great planning too - either opt in or out of prosthetic coverage for $4.00 a year.
Monday, May 4, 2009
WOW! Parity is on the move!
While I was focused on the lost cause of KS, Texas passed prosthetic parity into law! That makes 5 states just this year! (VA, MD, AR, IA, TX) That's incredible. It's time to focus on the national parity bill and stop beating a dead horse. The Amputee Coalition of America has a nice new website for the parity campaign. Check it out here.
Thursday, April 30, 2009
KS State Employees - Read this Now!
KHPA met with the EAC on March 4th to discuss adding electronic components to the State Employee Health Care Plan. Remember, KHPA does cover electronic components to State Medicaid recipients. This discussion is limited to the few State Employees that might require a prosthesis with an electronic component. You can read the memo here. When you read this memo, you'll also get a feel for the issues surrounding prosthetic parity and why we have to pass laws saying prosthetics should be covered like any other medical expense.
They have determined that it would cost the state $500,000 per year to cover electronic components for State Employee amputees. Their actual cost for my C-leg would have been $15,000 so this isn't adding up. If we use the State's predicted cost and divide it by the actual cost, we can assume that there are 33 State employee amputees that meet the qualifications for an electronic prosthesis. As far as I know I am the only squeaky wheel, because I've never heard about another State employee in this same predicament. Even so, let's pretend that there really are 33 eligible amputees employed by the state that are simultaneously prescribed and meet the requirements for an electronic prosthetic component in Year 1, costing the State $500,000. This is the predicted annual cost so in order to meet that requirement, another 33 amputees would have to show up year after year because the components last about 5 years. Catch my drift here? Those 33 would have to show up all in the first year to cost $500,000 and then what? Either another 33 show up the next year to cost the State another $500,000 or we take those figures and spread them out over 5 years for $100,000 a year. Of course, there may be costs for repairs, but we all know that there are not 33 State employee amputees clamoring for electronic components and this number is not going to multiply year after year. Bottom line? Totally bogus.
But, while we're in fantasy land, let's just say that this cost really is $500,000 a year. What would it cost the insured State employees if all the costs were passed on to them in the form of a premium hike?
There are roughly 90,000 State employees so 500/90 = $5.55 a year or 83 cents a month. Or, if we use the more realistic figure of $100,000 a year that's 9 cents a month. The insured State employees would have to pay somewhere between $0.09 - $0.83 a month to cover the cost of electronic prosthetic components for these imaginary 33 State employee amputees.
Just for fun, let's pretend I'm the only amputee in the State asking for the same prosthetic benefits that KHPA provides KS Medicaid recipients? What would I cost each and every KS State employee? The cost of my C-leg would have cost the state $15,000 and it's predicted to last 5 years so that's $3,000 per year. $3,000/90,000 employees = 3 cents per employee per year. Yes, that's what we've spent the last year arguing about - three pennies.
Premium hikes are a sore topic for KS State employees because they've been on the rise and are increasing even more next year, significantly more than $0.83 a year. Oh well, the people making these policies are KS State employees too. I doubt things will change unless a) a KS legislator steps up to the plate b) the federal prosthetic parity bill passes or c) one of these policy makers loses a limb and then comes face-to-face with the issue of parity.
They have determined that it would cost the state $500,000 per year to cover electronic components for State Employee amputees. Their actual cost for my C-leg would have been $15,000 so this isn't adding up. If we use the State's predicted cost and divide it by the actual cost, we can assume that there are 33 State employee amputees that meet the qualifications for an electronic prosthesis. As far as I know I am the only squeaky wheel, because I've never heard about another State employee in this same predicament. Even so, let's pretend that there really are 33 eligible amputees employed by the state that are simultaneously prescribed and meet the requirements for an electronic prosthetic component in Year 1, costing the State $500,000. This is the predicted annual cost so in order to meet that requirement, another 33 amputees would have to show up year after year because the components last about 5 years. Catch my drift here? Those 33 would have to show up all in the first year to cost $500,000 and then what? Either another 33 show up the next year to cost the State another $500,000 or we take those figures and spread them out over 5 years for $100,000 a year. Of course, there may be costs for repairs, but we all know that there are not 33 State employee amputees clamoring for electronic components and this number is not going to multiply year after year. Bottom line? Totally bogus.
But, while we're in fantasy land, let's just say that this cost really is $500,000 a year. What would it cost the insured State employees if all the costs were passed on to them in the form of a premium hike?
There are roughly 90,000 State employees so 500/90 = $5.55 a year or 83 cents a month. Or, if we use the more realistic figure of $100,000 a year that's 9 cents a month. The insured State employees would have to pay somewhere between $0.09 - $0.83 a month to cover the cost of electronic prosthetic components for these imaginary 33 State employee amputees.
Just for fun, let's pretend I'm the only amputee in the State asking for the same prosthetic benefits that KHPA provides KS Medicaid recipients? What would I cost each and every KS State employee? The cost of my C-leg would have cost the state $15,000 and it's predicted to last 5 years so that's $3,000 per year. $3,000/90,000 employees = 3 cents per employee per year. Yes, that's what we've spent the last year arguing about - three pennies.
Premium hikes are a sore topic for KS State employees because they've been on the rise and are increasing even more next year, significantly more than $0.83 a year. Oh well, the people making these policies are KS State employees too. I doubt things will change unless a) a KS legislator steps up to the plate b) the federal prosthetic parity bill passes or c) one of these policy makers loses a limb and then comes face-to-face with the issue of parity.
Friday, April 24, 2009
Grades for KS Health Care
I have been approaching this issue with a sense of humor, often laced with a little sarcasm, but tonight I'm just weary. It's been an exceptionally long day and I think I'm not only tired but terribly disappointed with bureaucrats, administrators, senators, commissioners, governors and just people in general.
The second appeal is final. It took 69 days for them to say "no," employing the same rationale, that is, electronic components (the C-leg and anything with a battery) are excluded. No explanation why, no explanation why amputees are the only group singled out with an "electronic exclusion" just, "Because we said so." That worked with me when I was 2 years old. It doesn't now. Decisions are based on reasoning.
Despite all the BS I was fed when they got wind of the Call for Action Report, the discriminatory and insulting language regarding insurance coverage for amputees will be left in the 2010 State Employee Health Care contract. The state will continue to practice disparity by providing proper care for amputees who are State Medicaid recipients, but not for their State Employees.
We did what we were told. We contacted the benefits office, BCBS of KS, then KHPA, then the KS Health Care Commission and the Governor. We talked to Senators and Representatives. Here's the breakdown:
Congressman Dennis Moore: They gave it a good run but got nowhere. Congressman Moore has yet to co-sponsor the federal prosthetic parity bill. I'll give him an A for effort and a C for not co-sponsoring the bill. Come on - step up to the plate and make a statement!
Former Governor Sebelius: Never responded to a single letter. She is now Secretary of Health and Human Services. She gets an F for failing to respond. I thought health care was a priority of the Democrats?
BCBS of KS: Please... they just wave their hands around and say they're not responsible for anything, they just administer the contract, take your questions to KHPA, it's not us, there's nothing we can do, we just handle the paperwork. They really are "just the messenger" so it's not fair to grade them on anything except their handling of the paperwork and communication which is, frankly, dismal. They get an F for communication in writing and a B for phone communication. There are some compassionate individuals there who clearly grasp the situation, but there's nothing they can do.
KS Health Care Commission: Never responded to a single letter. They get a resounding F for not recognizing the disparity, for not being outraged that State Employees aren't getting the standard of care and for lack of simple common courtesy.
KS Health Policy Authority: Responded immediately and favorably only when there was media pressure. Presented a good case to the HCC in February to change the contract language. I'll give them a B for their effort and understanding the disparity between State Employee benefits and State Medicaid Benefits but an F for not telling me about the Employee Advisory Committee.
EAC - who is the EAC? Good question. I'm just now hearing about them. Apparently, they are responsible (according to KHPA) for recently advising HCC not to change the State Employee contract language. I can't grade them because I don't even know who they are or how they based their decision.
When it comes to health care for working amputees, the State gets an F. There is so much finger pointing and lack of accountability that it becomes impossible to sort out why they choose to neglect their State employees and who is responsible. Maybe the new governor will be more responsive.
If are a KS State employee, or an amputee that has faced similar discrimination, contact me at katmanjo@gmail.com. I'm not giving up until we end this disparity.
The second appeal is final. It took 69 days for them to say "no," employing the same rationale, that is, electronic components (the C-leg and anything with a battery) are excluded. No explanation why, no explanation why amputees are the only group singled out with an "electronic exclusion" just, "Because we said so." That worked with me when I was 2 years old. It doesn't now. Decisions are based on reasoning.
Despite all the BS I was fed when they got wind of the Call for Action Report, the discriminatory and insulting language regarding insurance coverage for amputees will be left in the 2010 State Employee Health Care contract. The state will continue to practice disparity by providing proper care for amputees who are State Medicaid recipients, but not for their State Employees.
We did what we were told. We contacted the benefits office, BCBS of KS, then KHPA, then the KS Health Care Commission and the Governor. We talked to Senators and Representatives. Here's the breakdown:
Congressman Dennis Moore: They gave it a good run but got nowhere. Congressman Moore has yet to co-sponsor the federal prosthetic parity bill. I'll give him an A for effort and a C for not co-sponsoring the bill. Come on - step up to the plate and make a statement!
Former Governor Sebelius: Never responded to a single letter. She is now Secretary of Health and Human Services. She gets an F for failing to respond. I thought health care was a priority of the Democrats?
BCBS of KS: Please... they just wave their hands around and say they're not responsible for anything, they just administer the contract, take your questions to KHPA, it's not us, there's nothing we can do, we just handle the paperwork. They really are "just the messenger" so it's not fair to grade them on anything except their handling of the paperwork and communication which is, frankly, dismal. They get an F for communication in writing and a B for phone communication. There are some compassionate individuals there who clearly grasp the situation, but there's nothing they can do.
KS Health Care Commission: Never responded to a single letter. They get a resounding F for not recognizing the disparity, for not being outraged that State Employees aren't getting the standard of care and for lack of simple common courtesy.
KS Health Policy Authority: Responded immediately and favorably only when there was media pressure. Presented a good case to the HCC in February to change the contract language. I'll give them a B for their effort and understanding the disparity between State Employee benefits and State Medicaid Benefits but an F for not telling me about the Employee Advisory Committee.
EAC - who is the EAC? Good question. I'm just now hearing about them. Apparently, they are responsible (according to KHPA) for recently advising HCC not to change the State Employee contract language. I can't grade them because I don't even know who they are or how they based their decision.
When it comes to health care for working amputees, the State gets an F. There is so much finger pointing and lack of accountability that it becomes impossible to sort out why they choose to neglect their State employees and who is responsible. Maybe the new governor will be more responsive.
If are a KS State employee, or an amputee that has faced similar discrimination, contact me at katmanjo@gmail.com. I'm not giving up until we end this disparity.
Thursday, April 16, 2009
More State Victories!
HB 2244 was signed into law on April 6, 2009 making Arkansas the twelfth state to make prosthetic parity law! In addition, SB 1116 passed out of the Virginia House and Senate, as did SB 341 and HB 579 in Maryland, and HF 311 in Iowa.
So...Missouri, Iowa, Arkansas (a state with the word "Kansas" in it - we can dream, can't we?) and Colorado have all passed or are about to pass parity laws. Nebraska has legislation in place, Oklahoma and Kansas are still at stage zero with no one sponsoring a bill.
So...Missouri, Iowa, Arkansas (a state with the word "Kansas" in it - we can dream, can't we?) and Colorado have all passed or are about to pass parity laws. Nebraska has legislation in place, Oklahoma and Kansas are still at stage zero with no one sponsoring a bill.
Tuesday, April 14, 2009
Prosthetics on 60 Minutes
Prosthetic advancements were featured on 60 minutes recently. These stories, while inspiring, do not expose the dirty secret, that those amputees who work, have insurance and pay taxes will not have access to modern technology. Heck, the C-leg is something like 10-15 years old now - ancient by technological standards - but still more than the Health Care Commission can wrap their head around. Until either the cost of prosthetics decrease or the parity bill passes, these kind of advanced prosthetics will not be an option for the average working stiff.
What's wrong with this picture?
What's wrong with this picture?
Friday, April 10, 2009
State Updates
Iowa: Passed House and Senate, on its way to the Governor. Yeah!
Texas: Passed out of the House (105 yes, 35 no), on its way to the Senate. All 35 "no" votes were from Republicans who oppose the bill based on their philosophy that government shouldn't meddle in private affairs. Well, if someone had been paying attention in 2000 when insurance companies pulled a fast one it wouldn't have come to this, would it? See my previous post on mandating fairness.
Utah: Rep. HB 89 passed the House but never got a Senate vote. The bill would have affected up to 7,000 Utahns who need prosthetics. The sponsor of the bill, Rep. David Litvak (D-Salt Lake City), was told insurance companies won't offer coverage because the pool of users is too small to make it worthwhile.
Hey, "Peg"...How does that make you feel?
Think about this - the "pool of users" are the hard working, tax paying and premium paying customers of insurance companies that refuse to cover prosthetics. Prosthetics promote ABILITY. The ability to work, stay active and healthy and continue contributing to society you stupid, incredibly short-sighted pack of nincompoops! But then, we're not worth bothering with, are we? Don't these 7,000 people in Utah vote? I hope every single one of you is paying attention and make your voices heard. Gather up your friends, families and supporters and go march on the Capitol. Each one of you write a letter and have all your friends write too. "Too small to make it worthwhile?!" Utah advocates - put that phrase on your T-shirts and go make a scene!
Texas: Passed out of the House (105 yes, 35 no), on its way to the Senate. All 35 "no" votes were from Republicans who oppose the bill based on their philosophy that government shouldn't meddle in private affairs. Well, if someone had been paying attention in 2000 when insurance companies pulled a fast one it wouldn't have come to this, would it? See my previous post on mandating fairness.
Utah: Rep. HB 89 passed the House but never got a Senate vote. The bill would have affected up to 7,000 Utahns who need prosthetics. The sponsor of the bill, Rep. David Litvak (D-Salt Lake City), was told insurance companies won't offer coverage because the pool of users is too small to make it worthwhile.
Hey, "Peg"...How does that make you feel?
Think about this - the "pool of users" are the hard working, tax paying and premium paying customers of insurance companies that refuse to cover prosthetics. Prosthetics promote ABILITY. The ability to work, stay active and healthy and continue contributing to society you stupid, incredibly short-sighted pack of nincompoops! But then, we're not worth bothering with, are we? Don't these 7,000 people in Utah vote? I hope every single one of you is paying attention and make your voices heard. Gather up your friends, families and supporters and go march on the Capitol. Each one of you write a letter and have all your friends write too. "Too small to make it worthwhile?!" Utah advocates - put that phrase on your T-shirts and go make a scene!
Sunday, April 5, 2009
The Missouri Prosthetic Parity Bill (HB 616) passed out of the House Health Care Policy Committee unanimously (10-0) on April 1st
It's not an April fools joke either! Amazing that these bills are consistently passing unanimously, isn't it? This bodes well for the federal bills. So, ironically, Missouri is about to make it illegal to deny coverage for prosthetics. I live in Missouri, but I work for Kansas, so I'm still stuck. But, wonderful news for amputees in Missouri that have been doing without for so long!
Monday, March 30, 2009
Is your Representative or Senator on this list?
There are two federal bills for prosthetic parity:
1. House Resolution 5615 (HR5615) sponsored by Representative Robert E. Andrews [NJ-1]with the following cosponsors:
Rep Braley, Bruce L. [IA-1] - 5/13/2008
Rep Carson, Andre [IN-7] - 4/30/2008
Rep Clay, Wm. Lacy [MO-1] - 6/18/2008
Rep Coble, Howard [NC-6] - 9/9/2008
Rep Courtney, Joe [CT-2] - 9/23/2008
Rep Diaz-Balart, Lincoln [FL-21] - 3/13/2008
Rep Diaz-Balart, Mario [FL-25] - 3/13/2008
Rep Doyle, Michael F. [PA-14] - 6/18/2008
Rep Filner, Bob [CA-51] - 5/19/2008
Rep Fortuno, Luis G. [PR] - 9/15/2008
Rep Giffords, Gabrielle [AZ-8] - 7/10/2008
Rep Grijalva, Raul M. [AZ-7] - 5/19/2008
Rep Holden, Tim [PA-17] - 11/19/2008
Rep King, Peter T. [NY-3] - 5/7/2008
Rep Lowey, Nita M. [NY-18] - 7/10/2008
Rep Maloney, Carolyn B. [NY-14] - 6/18/2008
Rep Miller, George [CA-7] - 3/13/2008
Rep Nadler, Jerrold [NY-8] - 6/18/2008
Rep Payne, Donald M. [NJ-10] - 6/12/2008
Rep Petri, Thomas E. [WI-6] - 12/9/2008
Rep Platts, Todd Russell [PA-19] - 3/13/2008
Rep Ryan, Tim [OH-17] - 10/2/2008
Rep Terry, Lee [NE-2] - 9/16/2008
Rep Tierney, John F. [MA-6] - 9/9/2008
Rep Van Hollen, Chris [MD-8] - 9/23/2008
Rep Wamp, Zach [TN-3] - 6/18/2008
Rep Waters, Maxine [CA-35] - 6/18/2008
Rep Welch, Peter [VT] - 6/18/2008
See any representatives from KS or my representative from MO on this list? Hmmm...?
The Senate bill (S.3517) was sponsored by Olympia J. Snowe [R-ME] with the following cosponsors:
Sen Casey, Robert P., Jr. [PA] - 9/25/2008
Sen Feingold, Russell D. [WI] - 9/18/2008
Sen Harkin, Tom [IA] - 9/18/2008
Sen Inouye, Daniel K. [HI] - 9/18/2008
Sen Leahy, Patrick J. [VT] - 10/2/2008
Sen Sanders, Bernard [VT] - 12/11/2008
If you don't see your Senator or Representative on this list, take action now. Call, write, email, fax, whatever you need to do. The Amputee Coalition of America Advocacy Center has some good sample letters and links at the bottom of this page.
1. House Resolution 5615 (HR5615) sponsored by Representative Robert E. Andrews [NJ-1]with the following cosponsors:
Rep Braley, Bruce L. [IA-1] - 5/13/2008
Rep Carson, Andre [IN-7] - 4/30/2008
Rep Clay, Wm. Lacy [MO-1] - 6/18/2008
Rep Coble, Howard [NC-6] - 9/9/2008
Rep Courtney, Joe [CT-2] - 9/23/2008
Rep Diaz-Balart, Lincoln [FL-21] - 3/13/2008
Rep Diaz-Balart, Mario [FL-25] - 3/13/2008
Rep Doyle, Michael F. [PA-14] - 6/18/2008
Rep Filner, Bob [CA-51] - 5/19/2008
Rep Fortuno, Luis G. [PR] - 9/15/2008
Rep Giffords, Gabrielle [AZ-8] - 7/10/2008
Rep Grijalva, Raul M. [AZ-7] - 5/19/2008
Rep Holden, Tim [PA-17] - 11/19/2008
Rep King, Peter T. [NY-3] - 5/7/2008
Rep Lowey, Nita M. [NY-18] - 7/10/2008
Rep Maloney, Carolyn B. [NY-14] - 6/18/2008
Rep Miller, George [CA-7] - 3/13/2008
Rep Nadler, Jerrold [NY-8] - 6/18/2008
Rep Payne, Donald M. [NJ-10] - 6/12/2008
Rep Petri, Thomas E. [WI-6] - 12/9/2008
Rep Platts, Todd Russell [PA-19] - 3/13/2008
Rep Ryan, Tim [OH-17] - 10/2/2008
Rep Terry, Lee [NE-2] - 9/16/2008
Rep Tierney, John F. [MA-6] - 9/9/2008
Rep Van Hollen, Chris [MD-8] - 9/23/2008
Rep Wamp, Zach [TN-3] - 6/18/2008
Rep Waters, Maxine [CA-35] - 6/18/2008
Rep Welch, Peter [VT] - 6/18/2008
See any representatives from KS or my representative from MO on this list? Hmmm...?
The Senate bill (S.3517) was sponsored by Olympia J. Snowe [R-ME] with the following cosponsors:
Sen Casey, Robert P., Jr. [PA] - 9/25/2008
Sen Feingold, Russell D. [WI] - 9/18/2008
Sen Harkin, Tom [IA] - 9/18/2008
Sen Inouye, Daniel K. [HI] - 9/18/2008
Sen Leahy, Patrick J. [VT] - 10/2/2008
Sen Sanders, Bernard [VT] - 12/11/2008
If you don't see your Senator or Representative on this list, take action now. Call, write, email, fax, whatever you need to do. The Amputee Coalition of America Advocacy Center has some good sample letters and links at the bottom of this page.
Thursday, March 26, 2009
Trying to attain normalcy...
A few weeks ago my coworker Lori and I were out and about when we spotted a security guard on a Segway. I commented how cool that would be for the disabled, that they wouldn't be in a wheelchair, looking up at everyone, that they could be at eye level, moving along smartly and feeling "normal." Wondering if there were Segways for the disabled, I ran across this article.
I didn't feel good after I read it, in fact, I felt sickened. Why? Because it's another example of limitations for the disabled. See, everyone cheers if you beat the odds, perform amazing feats, but try to blend in and just live a normal life without wearing the big blue "D" on your chest, or try to use a mobility device or prosthetic that gives you an "advantage" (ha - advantage - how funny is that?) and you can find yourself in the situation this man did.
When I was between legs, waiting to see if my knee would heal, Dave made me a decoy leg out of Pringle's cans. I found that if I wore the decoy leg and used crutches, that strangers would joke with me and my co-workers felt more comfortable because a "broken" leg looked more "normal." Without the Pringle's decoy, people would either look the other way, avoid me altogether, or, worst case scenario, the other extreme - go slack-jawed, stare, point at the offending missing limb and blurt out, "What happened there?!" If this happens to you, be sure to quickly turn around and shout out, "Where?!" This should start an interest exchange of "Where?!" "There!" "Where?!" until you look down in horror and discover that your body part is missing whereupon you shriek in horror (don't hold back!), "Oh My GOD-MY-LEG?! WHERE'S MY LEG?!" then, as dignified as possible, walk off and leave them basking in their own stupidity and ignorance.
Anyway, give the article a read when you can - it's insightful and very well written.
I didn't feel good after I read it, in fact, I felt sickened. Why? Because it's another example of limitations for the disabled. See, everyone cheers if you beat the odds, perform amazing feats, but try to blend in and just live a normal life without wearing the big blue "D" on your chest, or try to use a mobility device or prosthetic that gives you an "advantage" (ha - advantage - how funny is that?) and you can find yourself in the situation this man did.
When I was between legs, waiting to see if my knee would heal, Dave made me a decoy leg out of Pringle's cans. I found that if I wore the decoy leg and used crutches, that strangers would joke with me and my co-workers felt more comfortable because a "broken" leg looked more "normal." Without the Pringle's decoy, people would either look the other way, avoid me altogether, or, worst case scenario, the other extreme - go slack-jawed, stare, point at the offending missing limb and blurt out, "What happened there?!" If this happens to you, be sure to quickly turn around and shout out, "Where?!" This should start an interest exchange of "Where?!" "There!" "Where?!" until you look down in horror and discover that your body part is missing whereupon you shriek in horror (don't hold back!), "Oh My GOD-MY-LEG?! WHERE'S MY LEG?!" then, as dignified as possible, walk off and leave them basking in their own stupidity and ignorance.
Anyway, give the article a read when you can - it's insightful and very well written.
Sunday, March 15, 2009
Breaking News About Federal Parity
Washington, DC, March 11, 2009 - On Tuesday, March 10, the Amputee Coalition of America had nearly 200 amputees and patient advocates from 34 states in Washington, D.C., to urge Congress members to support fair insurance coverage for artificial arms and legs. Their message was simple: Arms and legs are not a luxury!
These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.
“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country to do so. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”
Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.
“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.
Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”
In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.
“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”
These types of insurance company practices pose especially grave challenges for families of children with limb loss.
Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.
“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”
David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.
“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”
Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.
“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”
As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.
“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”
These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.
“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country to do so. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”
Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.
“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.
Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”
In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.
“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”
These types of insurance company practices pose especially grave challenges for families of children with limb loss.
Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.
“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”
David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.
“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”
Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.
“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”
As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.
“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”
Wednesday, March 4, 2009
Hmmm....
It's against the law now in 11 states to restrict prosthetic coverage. Leglislation is pending in 30 more states. That's 41 states in which legislation is either pending or passed. That leaves only 9 states in the dark and the Governor of one of those states is President Obama's choice for the Director of Health and Human Services. I've been reflecting on the appointment of Governor Kathleen Sebelius to Director of Health and Human Services for the last few days. It's weirdly ironic, that's for sure. Honestly, I don't know how I feel about it. Problem is, I'm trying to form an opinion with no evidence from the Governor or her appointees to the Kansas Health Care Commission that they really care about the issue of prosthetic parity because...well...frankly, because neither the Governor or her appointees have responded to a single letter that we've written. On the other hand they are considering changing the 2010 state employee health care contract. Ask me again in May when a decision is made on the contract. Ask me again when the Federal prosthetic parity bill gets sent to HHS. News from other states:
Utah - the House has passed a prosthetic parity bill. Opponents complain saying, "We won't have a market driven health care system." R-i-g-h-t. Market driven. I'm going to stop here before I say something profane. The cost? 18 cents per policy holder. "OOoo...I don't know. Should I get the policy with or without the prosthetic coverage in case I should have an accident and lose a limb or should I buy a chicklet?"
Virginia - SB 1116 was passed by the Virginia House on a 99 to 0 vote. There is one more bureaucratic step to make sure the Senate agrees to move the House version, but the bill should be on its way to the Governor's desk very soon. *UPDATE* The bill passed the House and Senate!
Maryland - (video)
Missouri - On March 10, 2009, the Missouri Senate Committee considering the Prosthetic Parity Bill voted unanimously (7-0) to pass it! It still has to pass the House committee and then the full House and Senate but this is a great start and speaks to the soundness of the bill. GO Big MO!
Kansas - Prosthetic parity? Here's an old fence post and a paring knife. Get to whittlin' there girl!
Wednesday, February 18, 2009
Visitors from the Other Room
Welcome - Seriously, you are welcome here. So, while you're here checking me out, let's chat a bit about how we got to this point and why I feel so strongly about this issue.Sometime in the late '90's insurance companies started to discontinue or severely limit prosthetic coverage with total disregard for transparency. It's easy to see how this slipped under the radar for a while, but then came the outrage.
We all know the importance of having health insurance. We pay premiums so that, in the event of a catastrophic illness or injury, there is a safety net. For amputees, some joker moved the net at the last second. Many people have to resort to loans, dipping into dwindling retirement savings, a second or third mortage or just doing without. Think of the trickle down effect this has on the economy and the long-term effects on health. It doesn't take a rocket scientist to figure out that I will generate more revenue for the state if I continue to work and stay active vs. going on the public dole and getting the proper prosthesis from state Medicaid. That's what's so crazy-making about all of this! It's this short-sightedness that has adds to the fiscal mess that's currently unfolding. Those states that have already passed parity laws have come to this realization.
So how did these parity laws come to be? How do insurance mandates happen? Sure, folks would like to blame the outraged amputee, the one-legged whiner stomping their singular foot - but - frankly, you brought it on yourself. When private insurance openly practices discrimination, you may save money in the short haul, but in the end, laws will be passed to mandate fairness.
Mandate fairness. It's kind of sad, isn't it?
Tuesday, February 17, 2009
More Obstacles
BCBS of KS sent me a letter last week saying they would expedite my second level appeal if I would "respond to this inquiry and send your reply to the expeditor." What inquiry? "This" inquiry. Was there a question, a query, a search for information or the truth? No. Word for word, that's what it said. I tried pressing the letter to my forehead but my Carnac the Magnificent skills have been lacking of late.It's moot anyway when you consider the State of the State. (click link to read article and see video) There are some interesting numbers in this article - KS has the worst benefits dollar-for-dollar, 40th in the nation for pay and there's a State Employee Union? I didn't know that! Now there's talk of not getting paid. This looks more like attention-getting political wrangling but I'll let you know on Friday.
Fighting for parity is hard enough but during a recession is nearly impossible. It seems every small gain is countered by a mammoth setback.
Friday, February 6, 2009
A trip to Topeka
I went to Topeka, KS today to attend a meeting of the Health Care Commission. This should be mandatory for anyone trying to make sense of how health plans work (or don't) for you. The reason it should be mandatory is because you can see both sides of the problem. On the one hand, the state has X-dollars set aside to provide basic health care to the insured state employees. Given budget cuts and the dismal economic outlook, keeping money in the state coffers to cover health care costs is going to be a challenge. I can appreciate that even more after this meeting. But, let's cut to the chase.Question: Should the state cover electronic prosthetic components? There was a lot of discussion surrounding this. It boiled down to either removing the electronic exclusion from the contract OR...putting a cap on prosthetics in general. That would have been the kiss of death. What about all those other whacky exclusions like comfort, convenience, etc.? They didn't come up. Some key questions that might give a person insight into the thought process are: Does Medicare and Medicaid cover this? (yes) Are there limits to who might receive such a prosthesis? (no direct answer here - that surprised me because there ARE) Is there an alternative approach, i.e., a limit (cap) on prosthetics? (strong arguments against this approach).
Cut! Rewind....
Prior to this discussion, it turns out that there was a KS Senate bill that required KHPA to conduct a study and determine whether to include bariatric surgery under medical coverage. A Senate bill (SB511) mind you! I don't know whether to stand here slack-jawed or pat myself* on the back for accomplishing the same thing for prosthetic parity without a Senate Bill. I'm not going to dwell on this except to say that there are now two issues concerning the 2010 health care contract - whether to include bariatric surgery and electronic prosthetic components. No decision was made today on either, but, to the credit of KHPA, they are going to convene a technology committee of prosthetists and medical doctors to learn more about prosthetics, how they operate, who needs them and why so they will no longer be in the "dark ages of coverage." (Their words, not mine.) Ultimately, the decision will be that of the Health Care Commission and I expect that decision will be made by May.
I know you might be thinking, "What's taking so long and how is that going to help you?!" Well, it's the government and look at the bright side - we didn't have to have a Senate Bill to get KHPA to do some research and convene a committee to look at fair coverage for amputees. As for me and my wonderful C-leg, it's probably too little, too late, to do me any good. Still, if we can accomplish prosthetic parity for state employees, then we've built the foundation for state wide parity.
I will say that I feel significantly less crazed, less like I'm trying to paddle up the Missouri river with a fly swatter. That's a good thing.
I'm going to go play some tunes now.
*this includes all of you - the friends, colleagues, senators, representatives and fellow amputees and above all, Dave, for giving up a perfectly good day to sit through a meeting!
Wednesday, January 28, 2009
Drum Roll - May I have the envelope please?
After two months, I received the response to my 1st level appeal to BCBS of KS. (The photo to the left would be considered a "covered" item - a sock pulled over a Pringle's can, stuffed in a shoe.)This is what I wrote in my "2nd level appeal." I have to exhaust all my appeals before I have the right to bring civil action. It's just a way to keeping dragging things out hoping I'll go away or get run over by a truck before they have to deal with me.
Thank you for the detailed review of my first level appeal. I can see by your response that you have given this matter a great deal of consideration. Indeed, it took 2 months to generate the following paragraph: [KFG: This is "Sarchasm" - The gulf between the author of sarcastic wit and the person who doesn't get it.]
"The items denied as non-covered were reviewed pre-service and notification was made to you that the micro-processor knee and lithium battery were considered electrical add-on items and were exclusions to the contract. The contract does not specifically indicate the denied items as ‘deluxe’; however, they do fall under the exclusion for charges for electrically operated prosthetic appliances, devices or items. This exclusion applies only to prosthetic items, not durable medical equipment such as a pacemaker, insulin pumps or other items indicated in your appeal. Therefore, the denials are correct."
[KFG: Woo-Hoo! They came right out and admitted that they only discriminate against amputees!]
Thank you for confirming that this exclusion is limited only to prosthetics. Therefore, by default, only amputees are affected by this arbitrary exclusion. That was precisely my point and your confirmation is very informative. While you are correct in that the contract does not use the word “deluxe,” I have several documents from your company and the Kansas State Employee Health Policy Authority that specifically use the word “deluxe” as a reason for denial. The word seems to have found favor since the 2009 State Employee Health Care Contract now denies amputees “deluxe enhancements, electronic components, microprocessors, performance enhancements, comfort, convenience and luxury items.” I’m not certain that there is a CPT code for comfort and convenience, but I can assure you that there is nothing comfortable or convenient about amputation and using a prosthetic limb.
Yada-yada, blah, blah, blah....
So, let me see...around the end of March, first of April, I should get back another thoughtful paragraph that says, "No."
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