Hanger Orthopedic of Bethesda, Md., and other advocates are lobbying lawmakers to mandate that private amputee coverage equal federal health insurance programs, such as Medicare.

Parity is critical, prosthetic makers and advocates say, because some insurers are hiking premiums and capping benefits, forcing some amputees to borrow from banks, max out their credit cards or shed assets to qualify for Medicaid in order to buy the artificial limbs or get necessary repairs.

The insurance industry, meanwhile, says it is providing cost-effective coverage to those who medically need such prosthetic devices. However, insurers oppose any such mandates for amputee coverage, arguing that it would simply make insurance less affordable to employers and raise health costs for the general population in the long run.

There are about 2 million amputees in the United States, including 701 service members from the wars in Iraq and Afghanistan, according to amputee and disabled veterans groups. Every year, about 75,000 Americans require amputations stemming from diseases, trauma or birth defects.

While amputees under military or government health coverage get needed care without worrying about financial limits or other restrictions, Morgan Sheets, the Amputee Coalition of America's national advocacy director, said tens of thousands of amputees or more with private insurance aren't getting what they expected to have.

Sheets' group has long lobbied for state laws that force private insurers to provide prosthetic care as a basic service, but started its federal campaign about a year ago. Sheets said Hanger, which hired Foley & Lardner LLP, is helping to fund the direct lobbying efforts.

The company, whose roots date back to the Civil War, is the 800-pound gorilla in the industry that designs, builds and fits custom-made prosthetics and orthotics, which are braces of some kind. The company accounts for nearly 25 percent of the $2.5 billion service industry, which is dominated by smaller private shops.

Hanger also started a political action committee last year to support state and federal lawmakers on a variety of issues, including parity, and expects to dole out $80,000 to candidates before the 2008 elections, said John Rush, Hanger's chief medical officer.

Several Republican and Democratic lawmakers have expressed interest in supporting federal legislation, which might be introduced early next year, said Sheets. But she said its success is unclear at this time.

Some insurers will only pay for one prosthetic during a patient's lifetime, cap payments up to $2,500, exclude repairs or require a 50-percent copay, Sheets said.

Tom Kirk, Hanger's president and chief operating officer, said an artificial leg can range in cost from $3,000 to $8,000, depending on an individual's needs, activity level and physical development, among other factors. Computer-assisted devices that adjust to different types of motion -- such as what Heather Mills McCartney used on the television program "Dancing with the Stars" -- could cost $40,000 or higher.

Rush said Hanger may reap some financial benefits if insurance companies improve care and provide higher reimbursement payments, but it is mainly doing this to support its patients.

Amputee advocates estimate mandating amputee care in private plans would raise premiums by about 12 to 25 cents per member per month. They also say the insurance industry will save money in the long run because amputees with appropriate prosthetics would avoid other dangerous health conditions.

Mohit Ghose, spokesman for America's Health Insurance Plans -- which represents 1,300 companies, including UnitedHealth Group Inc. and Cigna Corp. -- doesn't dispute the possible need for more prosthetic coverage, but said it must be weighed against other benefits in a health insurance plan.

"At what point does the benefit package become so large that the employer can't afford to provide it and the average employee can't afford to pay their fair share of the premium?" he posed.

Rush said insurance companies are sometimes afraid that people will abuse a mandated health benefit, but he said that won't happen here.

"No one is going to cut off their arm or leg to access this benefit," he said.

Amputee Coalition of America: http://www.amputee-coalition.org/

America's Health Insurance Plans: http://www.ahip.org/