Those with limb loss push back against ‘not medically necessary’ during day at capitol

There are over 35,000 Minnesotans living with limb loss, and thousands more living with limb difference and mobility impairments. Many are unable to access prescribed orthotic and prosthetic care due to a lack of insurance coverage, forcing individuals and families to incur huge out-of-pocket costs.

Some of their stories were shared at the state capitol on Wednesday, March 13, 2024.

The day-long event, called “So Every BODY can Move Minnesota” drew more than 100 advocates for two bills affecting people with limb loss and limb difference.  

The goal of the two bills is to change the climate of insurance denials for orthotics and prosthetics prescribed by physicians for the health of their patients. 

 

Elsa Keeler is a retired pediatrician. Five years ago, she was diagnosed with a rare form of bone cancer that required a full leg amputation. She received a prosthetic leg with a microprocessor knee, which was expected to last five years. Keeler is an active outdoors-person who loves to paddle in remote places like the Boundary Waters Canoe area. Her first prosthesis began to wear out after three and one-half years. When her doctor wrote a prescription for a replacement with a waterproof micro-processor knee, the claim was denied as “not medically necessary.” 

These are three words that every person living with limb loss or limb difference quickly learns to dread. Being denied an orthotic or prosthetic device prescribed by one’s physician brings a range of feelings including frustration, disappointment, shame, and anger.  

Like many advocates throughout the day, Keeler told stories about non-disabled relatives who received hip and knee replacements routinely so they could maintain their previous lifestyles. Artificial hips and knees  are internal prosthetic devices. Keeler said, “People needing external orthotic and prosthetic devices should have those same privileges, too.”

 

It’s estimated that about 500 Americans lose a limb every day. Limb loss can affect anyone at any time. Senator Karin Housely (R) co-authored the senate bill, and met with advocates including several orthotics and prosthetics tech students from Century College, which is in her senate district. 

The chief author of the senate bill is Senator John Hoffman (D), whose daughter Hope Hoffman was born with spina bifida. Her neurological condition has required multiple surgeries and prosthetic devices. Along the way, her family has had to push back against insurance claim denials that added to the frustration of living with a congenital condition. 

The bills before the house and senate are asking to amend current Minnesota law. They ask that state insurance plans be required to provide coverage at a rate equal to the federal Medicare program.

Insurance premiums across the board would only be expected to rise 39 cents per member per month, on average. Thirty-nine cents per month would make it possible for amputees to receive a waterproof limb to use while showering, or optimize their ability to bike, run, swim, or play any other ambulatory sport.. 

The final speaker in the rotunda was Governor Tim Walz. For the third year, the governor declared April as Limb Loss Month in the state of Minnesota. 

 

In the last activity of the day, coach Adam Warden of the non-profit Wiggle your Toes led a mobility clinic with games for kids, and high intensity exercises for participants of all ages.  

According to data from the Amputee Coalition, half of adults with disabilities get absolutely no aerobic exercise, and children with disabilities are twice as likely to develop obesity as those without. 

By contrast, people with disabilities who are physically active are more likely to be employed, advance in their careers, and have improved physical and mental health. 

Seven other states are introducing similar legislation for fair insurance compensation this year, and five others passed similar legislation in 2022 and 2023. 

To learn more about the bills before Minnesota’s house and senate, go to www.msopp-mn.com. The home page has a Call to Action. If you wish, you can push a button to email your Minnesota legislators and show your support of House File 3339 and Senate File 3351.