Prosthetic Limbs Spark Latest Insurance Backlash
12 03 08 - 12:26
Posted by Joe Mantone
As prosthetic limbs become more advanced and more expensive, insurers are balking at paying for the devices, the WSJ reports.
Many private health plans limit coverage to $2,500 or $5,000 a year, or pay for just one device per limb in a lifetime, even when the recipient is a child. No-frills prostheses can cost between $3,000 and $15,000, while more advanced models can cost as much as $40,000.
Device makers and amputees are pushing state lawmakers for legislation that would mandate coverage. They favor coverage similar to Medicare, which pays at least 80% of the cost of prostheses and allows for regular replacement of artificial limbs. Eight states have passed such requirements and 27 others are considering bills.
Insurers, however, say the requirements are bad for consumers overall and force small employers to buy expensive health plans.
"The issue isn't the merits of any single mandate," says Mohit Ghose, a spokesman for insurance lobby America's Health Insurance Plans. "It's what mandates collectively do to the affordability of health insurance." Proponents of mandates say the coverage would only add a few cents to monthly premiums.
For now, many amputees are stuck with plans that have fine print saying insurers are reducing their coverage. "You'd think that there isn't anything more basic than making sure someone has an arm and leg," says Keith Molinari, who found his private health insurance covered only a fraction of a basic prosthesis when his 10-year-old son, Chase, lost his leg to cancer as an infant.