Bob Reffi gets a prosthetic limb fitted. New York state Affordable Health Care insurance currently covers only one prosthetic device per limb, per lifetime. (Credit: CBS2)
As CBS2’s Carolyn Gusoff reported exclusively Tuesday, the standard health plans for the state limit how many artificial limbs a person can have – to exactly one.
After battling cancer and losing a leg, Bob Reffi’s first artificial limb wasn’t quite right.
“I was in terrific pain,” Reffi said. “I couldn’t walk.”
But a second prosthetic device made all the difference.
“It gave me back my life,” Reffi said. “I walk. I go on the beach. I fish.”
But under his new Affordable Care Act insurance, bought on the New York State Exchange Marketplace, there is no second chance. The state’s health insurers cover only one prosthetic device per limb per lifetime — no repairs, no replacements.
Only children are exempt.
Both patients and artificial limb manufacturers believe the rule is ridiculous.
“No person can live with just one prosthetic limb,” said Dan Bastian, an artificial limb maker.
Bastian said the artificial limbs don’t last forever. Bodies change, and technology improves.
But when it comes to state health insurers, that does not matter.
“They will not cover repairs or replacements,” Bastian said. “So it your prosthesis breaks, well, you’re out of luck.”
For Bastian, the fight against one limb for life is personal. He himself lost his leg 25 years ago.
“If I was limited to the first one that I received, I wouldn’t be able to do all the things I do,” he said.
John Kemp, a leading advocate for disabled people, was born without arms and leg. He wears four artificial limbs.
“More than occasionally do I need a repair or replacement. I just got new elbows,” he said. “Without having the insurance coverage, it is like a disability tax, and that’s not fair.”
A petition has been set up calling for change to the New York state restriction. National advocates said it violates civil rights.
“This is a really unprecedented and egregious restriction in coverage, and it really impacts people who are trying to go to work; go to school,” said Peter Thomas of the National Association for Orthotics and Prosthetics.
New York state officials said the restriction is not actually a lifetime limit, but a benchmark. Insurers can offer more.
But Bastian says they do not.
“There are no other plans that offer any other coverage,” he said.
Medicaid and Medicare cover repairs and replacements. So does the Veterans Administration.
But for the 3,000 new amputees in New York state each year, their first prosthetic device could be the last one insurance covers.
“It doesn’t make sense — why would you punish people?” Reffi said. “You’re not getting insurance for free, You’re paying for it.”
The New York Health Plan Association said the state sets the benefits, and only the state can change coverage. The organization added that it is required to keep premiums low, and cannot financially offer more.
An artificial limb can cost anywhere from $5,000 to $10,000.
Original Article: http://newyork.cbslocal.com/2015/03/17/cbs2-exclusive-nys-amputees-say-insurance-limits-them-to-one-prosthetic-for-life/