A News Health — 15 May 2015

Affordable Care Act (ACA) insurance plans offered through New York State of Healthcare, has committed what many are calling a grievous oversight – they are limiting adult amputees to “one prosthesis per limb per lifetime.”

ProstheticsAmputees are viewing the policy as discriminatory, as it is estimated that roughly 3,000 New York residents will lose a limb this year.

Due to changes in the body over time, as well as wear and tear on prosthetic devices, most amputees require new prostheses every 3-5 years; however, the insurance plans available under the Affordable Care Act in New York will not cover the replacement of prostheses for adults.

According to the website www.onelimbforlife.com, while children are not limited by this policy; “91% of amputations performed in NYS were on patients 45 years old and older.”

Metro-Ad2Furthermore, “In 2012 alone there were, 455 upper-extremity amputations, 1,526 below-the-knee amputations, and 1,326 above-knee amputations.

The site states that the policy is in violation of federal law, as the “One Limb for Life” rule is not “equal to the typical employer plan” in New York State, which is the standard for coverage under the ACA.  

Law makers and advocates are asking the health exchange director to revisit the policy and eliminate the restriction.

In an interview with NewsChannel 9, Syracuse, Marci Natale (Deputy Director, NY State Department of Health) responded, “We are aware of the issue and carefully evaluating and working on options to ensure that New Yorkers in need of prosthetics have the care they deserve, as well as that the state is in full compliance with all applicable federal laws and regulations.”

An online petition has been started by the Amputee Coalition, along with several other organizations, intended to change the “One limb for life” restriction.

According to the Amputee Coalition website, they are “currently working with coalition groups, partner organizations, professionals and advocates in New York and Washington D.C. to get this restriction invalidated by the agencies that oversee the Affordable Care Act, including the Department of Health and Human Services.”

“Each year, approximately 185,000 Americans undergo amputation of a limb and about 1,000 children are born with a limb difference. In fact, it was estimated in 2005 that nearly 1.9 million people in this country are living with the loss of a limb.” – Amputee Coalition

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Geoff Sims

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