Being edgy is hard on your health at least that's what Doc is always telling me. I've been doing pretty good not letting things get to me. Pretty good indeed...until the other day when I was talking to my cousin, who practices two counties away. He told me a story that was hard to believe. Jake has been known to pull more than prosthetic legs, but this story was so unbelievable it had to be true. It seems Jake got a call from a patient for whom he had made a leg a few years back, when the patient was an inmate at the state prison. Jake said the state is responsible for the healthcare of prisoners, so the state paid for the leg. The patient was calling to say he had been out of the state's custody for a few years and was doing well. He went on to tell Jake how he had been working hard to turn his life around, and he even had a job with benefits, including healthcare.
The man said he was calling because he was having trouble with the knee on his prosthesis. He said when he was carrying a heavy load on his construction job, the prosthesis would sometimes buckle, and he mentioned the socket was "kind of loose" too. The man said his foreman was afraid he was going to get hurt or hurt someone else. The patient asked if Jake would take a look, so Jake set up an appointment for him for the following week.
When the man came in for his appointment, his family came with him. He said his sons wanted to see where Daddy got his leg. Jake took one look at the leg and knew this man had been working hard at his construction job. He had built him a good leg with durable components, but four years of hard work had worn it out. His socket and suspension were shot too. The man had a prescription from his doc for a new leg, so Jake went ahead and cast him for a new one.
This is where it gets interesting...
The next day Jake's office manager called the patient's insurance company for authorization and found out his group health plan had a cap of $1,500 for durable medical equipment (DME), which they claimed prosthetic devices fall under. Jake's cost for the knee alone was more than that.
When Jake called the patient to give him the news, he said there was a long pause on the other end of the phone. Finally the man said, "So you are telling me when I was a castoff from society, a prisoner serving time for breaking the law, I had better healthcare than I do as a 'productive member of society'?" Now the long silence was on Jake's end. Finally Jake said, "Yeah, I guess that's true." Without a new leg, Jake's patient said he feared he would lose his job or, worse yet, end up back in prison. Then he half jokingly said, "Well I guess that would be one way to get a new leg." Jake said he wouldn't let that happen. He worked out a trade with the man for some construction work in his lab to cover the cost of the components and a payment plan on the balance left after his insurance paid $1,500.
Jake said he couldn't believe insurance companies would single out amputees as a way to save money. We both wondered how our state lawmakers could let this happen. Jake told me there was some hope thoughsomething called parity. Jake said he had read an article about parity legislation in another state, and it made a lot of sense. He said if everyone was covered, the increase in premiums would be less than 15 cents per month. On top of that, he read that for every dollar spent on prosthetics, $11 is saved in other healthcare costs. Imagine if Jake's patient hadn't been able to get a new leg and ended up back in the pokey. Two months in jail would have cost more than the price of that leg.
Stories like this have me heading for the Rolaids® faster than Jake's homemade chili. It just makes no sense, and we all ought to be a little edgy about parity. Me, I plan to focus my edginess on doing what I can to help get parity legislation passed in my state. Maybe my slogan will be "Help Stamp Out Stupidity. Give an Amputee a Leg." Maybe not. It's too long to fit on a bumper sticker.
Editor's note: EDGY, as you might guess, is an amputee who works in the O&P industry. You can e-mail your own EDGY comments and stories to OandPedgy@aol.com
