Recent legislature enacted in four of the fifty states in the U. S. (referred to as Prosthetic Parity Bills) ensures that amputees receive prosthetic coverage in their state. Currently, at least seven states have prosthetic parity bills before their legislative assemblies, with more states planning similar legislation. The obvious opponent in this debate is the insurance industry.

The majority of these parity bills mandate that insurers pay for prosthetic devices. In some states, they eliminate the ability for insurers to set limits on coverage for medically prescribed devices. This is of great interest here in the province of Alberta. We know an amputee whose insurance policy stated that prosthetic coverage existed, and who then received notification of changes made to the policy following an amputation, including a limitation of $1,000 per annum and non-coverage of myo-electric components. Again, these changes were made after amputation; the payor is claiming that this amputee must abide by the terms of the revised contract. The case is under legal review. With parity legislation, this situation could not have occurred.

In all likelihood, insurers will be asking for additional premiums to cover prosthetic services without limitations. In the U. S., it has been determined that these premiums amount on average to $.12/month per member-less than $1.50/year. In other words, to be provided with the appropriate care has little impact on the cost of insurance. In fact, figures show that appropriate attention to prosthetic issues would create a $500,000 savings in medical bills alone. Additional savings occur when a person returns to work and again pays income tax.

Individuals purchase insurance to cover unexpected, life-changing events, and amputation is one such event. In a publicly funded system, such as we have in Canada, there is no reason to set restrictions on the ability for a practitioner to provide meaningful patient care, i.e., quantity and frequency limits. Neither should amputees have to co-pay $500.00 per annum for prosthetic devices. This is effectively a tax on those whose physical ability has been impaired. There is no such deduction taken at the time an individual receives an amputation. Why is the prosthetist then asked to collect a deductible from the amputee?

Prosthetists, amputees, physicians, and anyone with a sincere interest in prosthetic services ought collectively to present a consistent voice to government, recognizing the value of coverage that allows individuals to work with their prosthetist to determine the appropriate device. We believe that quantity and frequency limits should not be permitted, nor should amputees be responsible for paying, and prosthetists be responsible for collecting, an annual deductible.