When Denise Batres was 7 years old, she was too young to understand the cancer growing in a bone in her leg or how her health insurance limited treatment for it. At age 16, though, a vibrant Batres recently took a day off from school to testify in California’s Capitol to advocate for state health insurance coverage of orthopedic implants.
In 2000, Batres developed osteosarcoma, a rare form of cancer that is most prevalent in children, forcing her parents to make a seemingly easy decision: Either try to keep the leg by using an orthopedic implant or amputate the leg altogether.
 Denise Batres testifies in California’s Capitol. (Courtesy of California State Assembly) |
But financial questions can make living with such decisions difficult. Medi-Cal California Children’s Services (CCS) insurance does not cover the costs of orthopedic implants. Medi-Cal, California’s Medicaid program, provides insurance to low-income individuals and families.
A patient of City of Hope pediatric orthopedic surgeon Dominic Femino, M.D., Batres traveled in April to Sacramento, Calif., to discuss orthopedic implant coverage. In a calm, soft voice, Batres explained to members of the Assembly Health Committee how her parents decided 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 does not pay for orthopedic implants when a patient goes through limb-salvaging surgery. In this surgery, physicians remove the cancerous bone and install an orthopedic implant in its place.
The payment method, in practice, means that the state prefers amputations over limb salvage. It is an unwritten policy that Assemblymember Ira Ruskin, from Palo Alto, is seeking to change though Assembly Bill 366. The proposed law would extend health coverage equally to orthopedic implants. Femino also traveled to Sacramento to speak with legislators one-on-one about the importance of the bill, which later passed the Assembly Health Committee unanimously.
It is 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.”
