Governor Kaine Signs Law Requiring Fair Insurance Coverage for Artificial Arms and Legs

A Virginia bill designed to ensure fair insurance coverage for artificial arms and legs was signed into law by Governor Tim Kaine last 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 said 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.”

Seven states (MD, IA, AR, VA, TX, MO and CT) have already passed prosthetic parity legislation this year. These states join the 11 other states (CO, ME, NH, CA, MA, RI, OR, NJ, IN, VT and LA) that have previously enacted laws.

The Amputee Coalition is now working with activists throughout the country to advance similar state legislation. Additionally, the nonprofit organization is working on a federal prosthetic and orthotic parity bill that has been introduced in the U.S. House of Representatives as H.R. 2575 and to re-introduce a bill in the Senate.

“We are fighting for people like Susan Bailey and even for those people who are not aware of their lack of coverage,” said Sheets, “but it’s a difficult battle. Insurance companies have a powerful voice, and the Amputee Coalition and our citizen lobbyists are like David taking on Goliath. Still, with the support of those like Governor Kaine and the Virginia General Assembly, we believe that we can help win this victory for American families.”

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