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Colorado bill would require insurance companies to cover athletic prosthetics for kids

Prosthetic legs
Posted at 5:14 PM, Mar 16, 2023
and last updated 2023-03-16 19:56:01-04

DENVER — At just five years old, Braden McMahon has a lot of big dreams for his life; when he grows up, he wants to be a soccer player and an astronaut, a NASCAR driver and even a monster truck driver.

Like most kindergartners, he also has a lot of energy and he doesn’t let anything slow him down, not even a prosthetic leg.

Braden was born without a fibula bone in his left leg. At 11 months old, his parents decided the best course of action was to amputate his foot so that he could get a prosthetic and start learning how to walk.

Because he is growing, Braden goes through about one leg per year and for the most part, his parents’ insurance covers the cost. The legs are expensive, though, and his parents end up paying about $600-800 for each one.

“This particular leg is deemed as medically necessary. But anything else like for sports, like running blades or anything like that, that's actually deemed not medically necessary,” Braden’s mom, Kristine McMahon, said.

Those legs can cost even more; Kristine estimates it would cost her about $10,000 out of pocket to buy her son a running blade. So, for now, he uses the only prosthetic he has for day-to-day walking and also for sports.

“A running blade would actually like give you a lot of spring. So, the whole like running blade foot would give you like the propulsion to like run a lot faster,” McMahon said.

The family has applied for grants in the past, but they take a long time to approve and then even longer to get fitted.

It’s why this legislative session Rep. David Ortiz, D-Denver, and a bipartisan group of lawmakers have proposed a bill to require insurance companies to help cover the cost of athletic prosthetics.

“We're being isolated, excluded and left behind,” Ortiz said during a recent news conference.

House Bill 23-1136would require state-regulated insurance plans to cover prosthetic limbs for those under 26 if their physician determines that it will maximize their upper limb functions. There are discussions, however, to broaden the bill even more with an amendment to remove the age limits.

"We cannot be making a Colorado for all unless we consider Coloradans that live with a disability,” said Ortiz. "If we are truly going to secure a Colorado for all, that must include Coloradans living with a disability."

The bill has the support of the American Academy of Pediatrics, the Colorado Consumer Health Initiative, the Colorado Cross-Disability Coalition, Disability Law Colorado and more. It also has a bipartisan group of state legislators signed on as its prime sponsors.

McMahon hopes that the bill will pass, saying that by paying for these athletic prosthetics now, medical insurers will actually save money in the long run.

“Bone degeneration, muscle degeneration, obesity, diabetes, stuff like that, that people don't really think about. If you curb that problem now, down the road it's going to be a lot less money to spend on someone that's healthy versus someone that is constantly needing medication,” she said.

There is no declared opposition of the bill. It is set to face its first committee hearing next Tuesday.

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