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Everybody Needs to Be EDGY about ThisBeing 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 
Table Of Contents - October 2007
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