Follow Up: A Story Inspired by Citizen Journalists Lands in Senate Health Care Debate

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Last week, Investigative Fund reporter Danielle Ivory brought you the story of 12-year-old Benjamin French and his family’s inability to pay for his $30,000 prosthetic arm.

Ivory discovered the French family through a call for citizen stories on health insurance. While combing through hundreds of tips from patients, healthcare providers and insurance insiders, Ivory stumbled upon a story from a pregnant California woman whose insurance company would not pay for her prosthetic leg. The woman said she was unable to convince her insurance company that her prosthetic device was not one-size-fits-all.

A few phone calls later, Ivory discovered a discrepancy in state insurance laws that left prosthetic patients in a bind -- 33 states don’t require insurance companies to offer any coverage for prosthetic devices. If they do offer coverage, they are permitted to impose lifetime coverage caps.

Benjamin hit his lifetime limit with Blue Cross Blue Shield after growing out of six prosthetics over 10 years. Now, his story has entered the debate over health care reform.

On Saturday, Sen. Debbie Stabenow (D-Mich.) described the family’s dilemma while on the Senate floor, calling on lawmakers to “eliminate those lifetime caps that get in the way of a 12-year-old being able to have the artificial arm that he needs...so he can lead a normal life.”

The French family was also the subject of a FOX2 Detroit profile, which showcased the hi-tech prosthetic device used by Benjamin.

Benjamin’s story spurred a number of questions about the device itself -- how can a prosthetic be $30,000? Ivory explains:

Many of our readers have been asking about Benjamin's arm and its hefty price-tag. Just to clarify -- Benjamin has been fitted with seven arms in 12 years. His first arm, called a passive prostheses, was a foam-filled rubber and plastic casing meant to help the five-month-old crawl. It was $5,000. Since then, he has been fitted with six increasingly expensive prosthetic arms with simple electronic components that allow his hand to open and close. These have ranged from about $8,000 to $30,000. All of his arms have been cobbled together with used parts from a limb bank, which has helped to lessen the overall cost. In addition, though Benjamin is an avid football and basketball player, he does not wear the artificial arm while playing sports because it might get damaged or hurt one of the other children. Some readers have suggested that the family obtain a cheaper prostheses on eBay.  Although people do buy and sell prosthetic devices online, the Food and Drug Administration prohibits the sale of prosthetics except by licensed practitioners. Patients can suffer permanent injuries from limbs that are not individually fitted -- giving insurance companies further grounds to deny coverage.

We have also received a number of requests from people looking to help the French family raise money for Benjamin's prosthetic arm. We'll keep you updated as we hear of opportunities.

Posted: 4:42 pm Nov 23, 2009
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