When a child develops bone cancer in an arm or a leg, surgeons can either try to replace the diseased bone with a special implant — or they can amputate the limb altogether. It would seem like an easy choice for parents.
For moms and dads in California relying on Medi-Cal California Children’s Services (CCS) insurance, though, the decision can be much tougher.
|Denise Batres testifies in California’s Capitol. (Photo courtesy of California State Assembly)|
Medi-Cal, California’s Medicaid program, insures low-income individuals and families. But the plan doesn’t cover orthopedic implants, which usually cost more than these families can afford.
That dilemma hits particularly close to home for 16-year-old Sonia Batres, so she’s doing something about it.
Batres was 7 years old when she developed osteosarcoma, a rare form of cancer that mostly hits kids. Now 16, she recently testified in California’s Capitol to advocate for state health insurance coverage of orthopedic implants.
A patient of City of Hope pediatric orthopedic surgeon Dominic Femino, M.D., Batres traveled in April to Sacramento, Calif., where she calmly told members of the California legislature’s Assembly Health Committee about her parents’ decision and how they chose to save her leg.
“My parents were told that my leg could be amputated or that doctors could remove the bone and replace it with an orthopedic implant,” Batres said. “They were told that an amputation was covered by Medi-Cal/CCS, but if they decided to save my leg with an orthopedic implant, I wasn’t insured.
“My parents decided to remove the bone and save my leg. I like to swim and they thought swimming with one leg would be hard.”
Medi-Cal, which provides health insurance to 6.5 million eligible Californians, pays for the cost of external prosthetics when a patient goes through an amputation. However, it doesn’t pay for orthopedic implants when a patient goes through limb-salvaging surgery. In this surgery, physicians remove the cancerous bone and replace it with a special implant that keeps the limb in tact.
In practice, the payment method means the state prefers amputations over limb salvage. It’s an unwritten policy that Assemblymember Ira Ruskin, from Palo Alto, is seeking to change through Assembly Bill 366. The proposed law would extend health coverage equally to orthopedic implants. Femino has spoken to legislators to support the bill, which successfully navigated the Assembly Health Committee and now awaits Senate Health Committee approval.
It’s a change that Batres wants to be a part of, too.
“I want to make a difference in people’s lives,” said Batres. “I want people to have the options I had with my cancer treatment, and I want people who receive Medi-Cal/CCS, like I did, to be able to find good doctors who can perform the surgery just like I did.”