The bill would bring insurance coverage for prosthetics in line with coverage for other medical conditions. Right now some insurance companies refuse prosthetic coverage - even for children - claiming arms and legs are "items of convenience."
H.B. 343 would remedy that situation - at NO COST TO THE STATE - and for an average cost to the policy holder of $2.00 per year. Decisions don't get much easier than that.
Imagine waking up with a limb. You're suddenly without an arm or a leg. Imagine losing more than one. (See the video)
Then imagine what it would be like to discover you or a loved one could only have one prosthetic for their entire lifetime.
Many amputees don't have to imagine. They live it. The reason is that different insurance companies cover prosthetics at radically different levels.
Some cover 80% or more of a medically necessary prosthetic. Others impose a replacement or repair coverage cap of as low as $500 per year. Still others allow an individual only one prosthetic for their lifetime.
That's bad enough if for a grown adult - but it's completely unacceptable for a growing child.
The ProblemThe basic problem is that the overall insurance industry classifies prosthetics as "durable medical equipment" - the same classification it uses for wheelchairs, oxygen equipment and home hospital beds.
We can see why insurance companies might want to limit the number of hospital beds you could get in a lifetime. But prosthetics aren't just hardware to us.
They are - quite literally - extensions of our bodies which allow us to walk, grasp, work, play, travel, socialize, engage in sports and recreation and to lead a full and active life.
The Objective - Parity With Other Health CareThe objective of Prosthetic Parity legislation is to put prosthetics on a par with other medical benefits. In other words, to make sure group health insurance plans cover prosthetics, components and repairs under terms that are no less favorable than the coverage they provide for other medical and surgical benefits.
At minimum, proposed federal legislation requires that insurance companies provide prosthetic coverage at least at the same level as provided by Medicare.
Prosthetic Parity legislation also generally eliminates annual or lifetime dollar limitations on benefits for medically necessary prosthetics, components and/or repairs.
No Premium IncreasesA primary opposition to any legislation is the cost factor - who's going to pay for it and how much?
1: Prosthetic parity legislation will not add to the size of government or to the costs associated with the Medicare and Medicaid programs, and
2: "prosthetic devices on par with other medical and surgical benefits will not increase the incidence of amputations or the number of individuals for which a prosthetic device would be medically necessary and appropriate."
In other words, people aren't going to be lining up to have a limb lopped off so they can take advantage of the insurance coverage.
The States in which prosthetic parity laws have been enacted found there to be little or no increases in insurance premiums
The New Jersey Mandated Health Benefits Advisory Commission, for example, reported “The cost impact on premiums is relatively small - at less than 0.025%.”
States where Prosthetic parity is now law also report reduced Medicare and Medicaid costs. That's good news in support of the federal bills.
Sponsors of H.B. 343
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