Unlike Medicare or Medicaid, private insurers often cap annual coverage for prosthetics. In recent years, some insurers have reduced or eliminated these caps, driving up patient costs for already-expensive prosthetics and sparking a nationwide push for so-called “prosthetic parity,” or an equality in prosthetic coverage for public and private insurers. The almost decade-long effort is making headlines again, with several states passing or considering legislation in 2008 and 2009.
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Eleven states have passed laws requiring private insurers to offer prosthetic coverage equal to Medicare standards or to hip and joint replacement coverage, and amputee advocates are pushing for legislation in a number of other states (including Pennsylvania, Utah, Texas, Idaho and Iowa) and at the federal level (alternative link).
The organization behind the campaign, the Amputee Coalition of America, estimates that almost 2 million Americans are living without limbs, and says 185,000 more amputations are performed each year. The ACA says that while prosthetic limbs often have a lifespan of 3 to 5 years, many private insurers either place a lifetime cap on coverage of prosthetic purchases or will only cover the purchase of one such device during a patient’s lifetime. According to the ACA, financial hardship is the main obstacle preventing amputees from gaining access to prosthetics.
It is well known that lack of access to these devices leads to poor rehabilitation outcomes, and places amputees at a greater risk of developing dangerous and costly secondary conditions such as obesity, diabetes, cardiovascular disease and additional amputation. These in turn lead to decreases in mobility, productivity and the ability to live independently. These factors combine to create additional costs of care, significantly impact the quality of life and shorten life expectancy.
Here’s the ACA’s campaign and talking points (PDF).