Saturday, October 4, 2008

Sample Letter

Below is a sample letter that you can send to your state representatives. Please read post above for instructions:

Dear (Senator or Representative),

I am writing on behalf of Dr. Kathleen Gustafson, a state employee at University of Kansas Medical Center. I came to know Kathleen through a mutual source with the Western Kansas Limb Loss Support Group. Dr Gustafson is having a problem getting the state insurance KHPA to cover the micro-processor leg (called a C-leg) she needs to continue living an active, normal life.
Dr. Gustafson was advised to write to the Kansas Health Care Commission and ask that they reconsider the policy that refuses to cover a prosthetic microprocessor knee. Current policy considers the knee to be "deluxe" and therefore, a non-covered item. Concerned that Dr. Gustafson’s single voice may not be heard, I am writing to plead her case.

Kansas Health Care Policy for 2009 reads:

"Coverage is limited to the basic (standard) appliance or device which will restore the body part or function. If you elect to purchase a prosthetic appliance or device with deluxe enhancements or features such as electronic components, microprocessors or other features designed to enhance performance, the Plan is only responsible for the amount that would have been allowed for a basic (standard) appliance. You will be responsible for paying the additional cost of the deluxe enhancements, electronic components, microprocessors, performance enhancements, comfort, convenience or luxury items.

Repairs - Repair or replacement costs for any otherwise covered device necessitated by loss, misuse or abuse of items owned by the Member. Charges for deluxe prosthetic appliances or devices with deluxe enhancements or features such as electronic components or microprocessors are not covered.

Prosthetists, the FDA, CMS/Medicare, AAOP, the VA, and over 150 insurance companies have recognized and accepted microprocessor-controlled knees as a standard level of prosthetic treatment. They have been used in thousands of above knee amputees - since 1997 in Europe and Canada and 1999 in the United States. Further indication of acceptance of microprocessor-controlled knees is Medicare’s assignment of L-Codes L5847 and L5989 in January 2002, the code L5848 in January 2003 and the code L5846 in January 1996. Research and patient reports show the microprocessor knee to be superior to simple hydraulic knees with improved patient function and mobility, fewer falls and injuries and less wear and tear on the sound limb.

Microprocessor knees are also standard of care for KS Medicaid recipients. Why is the standard of care different for KS State Employees? Dr. Gustafson is a valued employee of the State’s premiere medical and research center and her mobility is essential to her job and highly active lifestyle. Yet, the ability to walk normally, without assistance, is considered a luxury? Please reconsider and change this policy.

As a citizen of Kansas and a fellow amputee, I am appealing to you as a leader in the state of Kansas to assist Dr. Gustafson in obtaining the prosthesis that she needs to be able to continue to work, enjoy life, and live the normal life that is the right of every citizen.


Phone No.

Bob Barker
Western Kansas Limb Loss Support Group


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