Amputee Health Coverage: US advocates fight against costly medical bills

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Advocates in the United States say many insurance plans don't cover the basic needs of people who've lost limbs. Many face overwhelming medical bills and can't see specialists. CGTN's Giles Gibson reports community leaders push for "insurance fairness" in every state.

Six-year-old Nathan Simm's prosthetic leg lets him play like any other child. Born with a rare condition, he became an amputee when he was just a year old.

SHANNON SIMM NATHAN'S MOTHER "When he has pants on, you have no idea he has a prosthetic limb. He's active, he's fine. There's no pain. He's not getting calluses or sores or wrinkles or anything."

His mother Shannon says his prosthetic costs around twenty thousands of dollars. And she says it's a constant battle to get insurance coverage for everything Nathan needs.

SHANNON SIMM NATHAN'S MOTHER "When you call a prosthetic limb a luxury, that's ridiculous. It's an everyday necessity."

This is Nathan's seventh prosthetic. As he keeps growing, he'll soon need another, as poorly-fitting prosthetics make him less mobile and more likely to be in pain. But amputee advocacy groups say health insurance plans often limit coverage to as little as a thousand dollars a year.

GILES GIBSON OCEAN CITY, MARYLAND "This family is just one of thousands across the U.S. that's dealing with the everyday challenges of limb loss. The Amputee Coalition says there are approximately 185,000 new amputees every single year."

Twenty-one U.S. states have now passed what advocates call fair insurance legislation. The laws strip away arbitrary price caps and treat prosthetics like internal medical devices such as pacemakers, instead of wheelchairs or crutches.

JACK RICHMOND CEO, AMPUTEE COALITION "For me, my prosthesis is a part of my body."

Jack Richmond lost his leg 30 years ago after an accident at work, but has since run five marathons as an amputee.

JACK RICHMOND CEO, AMPUTEE COALITION "What we have available is much more advanced than it was 30 years ago. We compare it, and we say insurance companies are willing to pay for the other technologies, why is prosthetics carved out as being something they don't want to reimburse many times."

America's Health Insurance Plans, a group that represents healthcare insurers, told us in a statement.

"It would not be accurate to say that this critical treatment and device is considered a 'luxury'. Health insurance providers do cover prosthetics - including repairs or replacements - when medically necessary, which is typically to replace a missing or non-functional limb or organ."

The Amputee Coalition says its goal is to get "Insurance Fairness" in every state, meaning two million amputees across the U.S., including Nathan, can get the coverage they need to live a full life. Giles Gibson, CGTN, Ocean City, Maryland.