Affordable Care Act, how it is affecting amputees and prosthetic services

Affordable Care Act, how it is affecting amputees and prosthetic services

Jim DeWees

4/14/2014

Hello Everyone,

I need some help here today. Any information would be helpful.

Tomorrow morning, a local TV reporter for the PBS station is coming to do a
story on how the Affordable Care Act is affecting my life.

I was featured on the PBS Weekly Special last week about how my accident,
and losing my leg, changed my life, and how my work in the Dominican
Republic is helping amputees there.

When this producer was in my office, I was in the middle of a battle with
my new insurance over getting a prescription filled for my son. I put this
on speaker phone so that this producer could hear the craziness of this
conversation and how difficult it is to deal with this Market Place
(Obamacare) policy. She was SHOCKED.

Now another producer/reporter is interested in the way this new insurance
situation will affect me and my son (both are amputees) and our access to
prosthetic care.

She also wants to know how it if affecting Prosthetic clinics, if we are
having more problems today in providing quality prosthetic limbs to the
amputees.

Any good information from any of you will be helpful.

Personally, I have a NEW insurance policy as of Feb. 1, 2014. I have
always had insurance, and pay out of pocket for my own family policy. It
was with a company from Ohio, and due to the changes in the laws, they are
no longer allowed to sell insurance in Indiana or any other state than Ohio.
No other insurance company would offer me a policy, because they were not
doing any individual policies in Indiana.

I was forced to choose between 2 companies who offer policies in Indiana.
The price for a family policy in the ACA Marketplace is between $1300 to
$1500 per month (Gold plan, 80% coverage, etc.) This is about $450 more
than my previous policy.

I called this insurance last week to find out IF I have any coverage for
prosthetics, and YES, I do have in-network benefits that cover 90% of the
allowed amounts. BUT the problem is there are NO providers in the network
to do prosthetics. They will negotiate with an out-of-network provider,
but their rates to do that are about 50% of the Medicaid rates. NOBODY can
afford to make a good K-3 level prosthetic leg, silicone liner, suction
socket, for about $3500.

Anyway, that is what is going on in Indiana. If anyone can help me with
information from other states, I have a 30 minute spot on PBS to share these
stories about how the ACA is affecting us.

If there are GOOD stories, I would like to hear them.

If they are BAD stories, I also want to hear them.

Thanks

Jim DeWees, CP