About Me

My photo
I am a below knee amputee. More importantly, I am also Mommy to two boys, a very active 10 year old (Robby) and an mischievous toddler (Timmy). I have learned that being a parent with a disability can create some unusual and sometimes humorous situations. This blogger is available for hire! Let's talk and learn how a blog can expand your business.

Friday, July 31, 2015

Medicare Proposals- Time to Act!

In terms of technology, there is no better time to be living with limb loss. I have witnessed the great strides made in suspension systems, socket design and components during the decade since I became an amputee. From high tech bionic devices to specialized fins for swimming and blades for sprinting, the possibilities appear endless. Alas, the dirty little secret of accessibility to devices continues to limit the potential of amputees across this country. 

Medicare recently proposed changes which, if enacted, could significantly impact the millions of amputees in this country who rely upon a prosthetic device. It is important to understand that private insurers, including Blue Cross, Cigna, and United, typically follow Medicare's lead. If these disabling proposals materialize, it is assumed that they will be adopted by all insurers without hesitation. 

The proposed changes are lengthy, but I will highlight and attempt to clarify the five that I feel are the most dangerous.

1. All new amputees must complete a rehabilitation program utilizing a "preparatory" prosthesis. An individual must prove competency on the bare bones device before progressing to a definitive device. This proposal will force the amputee to utilize a device that does not meet their needs and is flawed by the assumption that one must be adept at lower technology devices in order to utilize and benefit from technology. There are many above knee amputees who are able to ambulate because of the microprocessor knee. If they were forced to prove competency with a preparatory prosthesis, they would be unsuccessful and would not qualify to receive a prosthetic under the proposed regulations. 

2.  The patient's potential will no longer be considered when prescribing a prosthetic device. Currently, a prosthesis can be provided if the team proves that the patient has the potential for increased activity once the device is received.  Instead of providing tools to enhance an individual's abilities, the prosthetics provided will meet only the current functional level. In other words, if you weren't going to the gym before your amputation, don't expect to become healthy now that you lost a limb. So much for the government's Get Moving campaign!

3.  Regardless of your current abilities, if Medicare has ever provided an assisted mobility aid (crutches, knee scooter, wheelchair), your prosthetic can be denied. I was provided with both crutches and a wheelchair following my amputation. Under the current proposals, this could be terms for a denial.

4.  If an amputee is not deemed to demonstrate a "natural gait" utilizing the preparatory prosthesis, the more sophisticated device can be denied.  Yikes! How much of a limp can be present has yet to be clarified, but this is a dangerous precedent. Not everybody with two legs ambulates with a smooth looking gait, yet amputees are going to be held to a higher standard than the regular population. 

5.  The prosthetist, the college-educated expert in the craft, will no longer be considered relevant in determining the components for a prosthesis. With his expertise muted, these professionals are relegated to basic suppliers. The determination of components will be made by a medical team which lacks insights into the various features of the available devices. 

I used to believe that amputees could do anything and that we were limited only by their own desires and motivations. I have come to realize that the community is disabled not by the physical loss of their limbs, but by the archaic insurance policies that stymie our potential through denials and by limiting available technology. These Medicare proposals threaten to put prosthetic access out of the reach of millions of people in this country, and it is time we stood up and fought back. We may be living with limb loss, but we will no longer be disabled by insurance companies. Help me stand up to these Medicare proposals by writing to your elected officials. Together, we can make our voices heard. 

No comments:

Post a Comment