US Politics: Competitive Bidding for Prosthetics

[Wayne Renardson]

One day Justin Foster wrote:

JF> If our "patients" would accept some of the financial burden, and quit 
expecting insurance to cover the latest and greatest in prosthetic (and orthotic 
for that matter) care, then we wouldnt have this problem.   

I will assume from this you are new to prosthetics. I am BK from a 
motorcycle accident 30+ years ago...1969. Who does you think spends 
millions on advertising the 'latest and greatest' if not the prosthetics industry? 
Check out your publications or 'In_Motion' magazine from ACA,  marketed to 
amputees. 

I use a PTB with hard socket, 1 3x wool sock, Smith suspension, and a Flex 
foot that was given to me by a friend since my insurance (BC/Blue Shield of 
Tennessee) allows $1000/year for prosthetic coverage. It is not the latest and 
greatest.My coverage is insufficient to buy a foot let alone the latest and 
greatest. Then there are those with NO insurance coverage or whose 
insurance will not pay due to "pre-existing conditions."   

JF> Then normal business/market pricing could be bourne out. 

Normal?  Does that mean the prosthetists will stop marking up products 300% 
or more? 

JF>If I want to have a hi-end bicycle, or a great pair of skiis, I have to pay for 
it...  

The difference is--a prosthesis allows me to (1) walk, (2) avoid crutches or a 
wheelchair (3) get to work, and (4) earn a living. 

Comparing what I NEED in order to eat and put a roof over my head to a 
Pugeot bicycle (which is a WANT--not a need) or skis (which I doubt you 
NEED to put food on your table) is at best supercilious. 

JF>...how can we continue to expect insurance to pay for $1500 liners, flex 
feet, and computer controlled knee joints??? 

If you had contact with amputees (real live ones) you would know many have 
no insurance or have limitations on coverage as above. 

JF>Maybe this is why payors are going bankrupt! 

Please name just one insurance company that has gone bankrupt due to 
amputees? 

JF>I understand the medical need for a prosthesis or orthosis, but I believe we 
have overstepped our bounds again and again on what is "medically 
necessary" for our "patients" (often really clients)  

And that is due to uninformed physicians writing a Rx for gear about which 
they know little or nothing. Let us not forget that some prosthetists might also 
recommend gear that is much more complex than their end-users NEED, but 
want. There is also a whole lot more money in the prosthetist's pocket to 
recommend the high-end gear that indeed may not be medically necessary.      

But this is too much:

JF> Take a look at what people are walking on in other countries... 

Uhhhhhhh-------excuse me. I suppose I should use a homemade piece of 
wood, a Jaipur foot made from tire retreads, and hold it all together with a 
piece of leather. For that I worked in the USA for 30+ years, paid insurance 
premiums since I was 21, only to be told 
I am limited to $1000 a year?  Comparing the USA to Nigeria is what we call 
a bad analogy. 

JF>Let's take off the kid-gloves and handle our "patients" like any other 
responsible consumer;  

I like to think of myself a a responsible consumer. 

JF...we survive, manufacturer R&D can continue just like other industries, 
patients have a greater interest in products available... etc!!! Everybody wins!  

Rest assured we want you to survive. My ability to walk and get from point A 
to B depends upon a skilled prosthetist. And while companies do engage in 
R&D, much as the pharmaceutical industry claims, much of their overhead is 
really spent on advertising and convincing prosthetists and users they NEED 
their product. 


Wayne Renardson