Nov 12
Prosthetics Insurance
In January of 2007 a new state law took effect in Massachusetts that requires health plans to provide coverage for prosthetic limbs The law also prohibits insurers from imposing annual spending limits specifically for artificial limbs.
The director of legislative affairs for the Massachusetts Society of Orthotists and Prosthetists commented that the law should end “woefully insufficient” coverage provided by some insurance plans.
The costs of prosthetic limbs vary widely. For example, an arm carries a minimum price tag of $3,000, while a body-powered above-the-knee prosthetic can cost as much as $52,000. The average cost of a prosthetic limb ranges between $10,000 and $15,000.
Proponents of the legislation said that some insurers restrict coverage of artificial limbs by imposing annual caps or limiting benefits to one limb per lifetime.
“In recent years we’ve seen more and more insurers reduce or eliminate their coverage” for prosthetics, the advocacy director for the Amputee Coalition of America, a nonprofit group based in Knoxville, Tenn. In a recent membership survey, the ACA found that 24 percent of its members had experienced reductions in healthcare coverage for prosthetics, and 4 percent had benefits eliminated altogether.
Massachusetts is the fifth state to enact a law mandating prosthetic coverage. In 2001, Colorado was the first to pass a so-called “prosthetic parity law,” followed by Maine, New Hampshire, and Rhode Island. California recently passed a similar measure, which will soon become law unless the governor vetoes it, according to the Amputee Coalition of America. This issue has become a cause similar to coverage for mental health problems, another area where health insurance companies have traditionally been cavalier about coverage.
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November 13th, 2007 at 10:45 pm
I am having trouble seeing how an insurance company could reasonably refuse coverage for a prosthetic device – what exactly do they expect their insured to use instead? Sure, they might not need to cover the computerized, marathon-runner prosthetics, but come on. The injuries or illnesses which would lead to the need for prosthetics are terrible enough… to deny coverage for something which could give someone a semblance of normalcy in their lives is simply cruel.
Jerry
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