Bill removes cap

Sunday, May 31, 2009

SACRAMENTO--A bill that would require private health insurers to cover durable medical equipment passed the California State Assembly Committee on Health in April, but it still has a long way to go, say stakeholders.

“It still has opposition from the health plans,” said Bob Achermann, executive director for the California Association of Medical Product Suppliers (CAMPS). “Even if it passes and gets to the governor, the governor has consistently vetoed all bills that have a health care mandate for insurers.”

While DME like crutches, hospital beds and oxygen concentrators is covered under Medicare and Medi-Cal, 90% of private insurance plans cap the benefit at amounts from $500 to $2,000.

“For people who have serious health conditions, those limitations hurt them,” he said. “They have to pay out-of-pocket for what is a necessary health benefit.”

The bill, A.B. 214, is similar to a bill introduced - and defeated - last year. While Achermann understands why insurers don’t like such mandates, in the long run, providing adequate coverage for these products saves money for everyone, he said.

“(DME) keeps them out of a hospital or the nursing home,” Achermann said. “They can work; they have private insurance. It’s sad in some cases, the state ends up paying more because when the benefits are exhausted (the beneficiary) has to go back on Medicare or Medi-Cal.”