Prosthetic bill back in action

Tuesday, June 30, 2009

WASHINGTON--Advocates for better insurance coverage of prosthetics are gearing up for round 2, thanks to a new bill introduced in June.

Sponsored by Rep. Robert Andrews, D-N.J., H.R. 2575, would require insurers to include prosthetics and custom orthotics under major medical coverage.

“We’re not asking for a free ride,” said provider Joe Sansone, CEO of TMC Orthopedic in Houston, Texas. “All we are asking is that people who work and pay for health insurance premiums actually get their limbs covered.”

A similar bill last year garnered widespread bipartisan support and industry stakeholders expect the same this time around.

One caveat: This year’s version includes custom orthotics, which some stakeholders feared could muddy the waters.

“We do run a slight risk of some legislators thinking it’s mandating a bit much,” said Sansone, who provides both. “But if we don’t pass a law like this, the same issues we have had with prosthetics, we will have with orthotics.”

Many states have enacted similar laws in recent years, most recently Texas and Maryland in May.

That’s encouraging, said Greg Safko, president of the Board of Certification/Accreditation, International.

“(Prosthetic parity) holds as much promise and strength on the federal level as it does on the state level,” he said. “It’s a very compelling argument.”

The biggest opponents to such laws tend to be insurers and business owners who argue that such mandates will drastically increase health care costs, but advocates have cited several studies that suggest that isn’t the case.

“These bills only increase premiums, on average, by 12 cents per policy per month,” said industry stakeholder John Rush, who has worked on many similar bills. “The highest we’ve found is 32 cents and in some states, the increase has been as low as 2 cents to 8 cents.”