Prosthetic Parity - House Bill 310

There are 40,000 people in Ohio living with limb loss.  Many of these people live with the serious financial strain and debt that is caused by underinsurance of prosetics.  Current insurance plans are having a devastating effect on amputees and their families because they classify prosthetic limbs as Durable Medical Equipment.  Durable Medical Equipment more accurately means equipment like canes, crutches, walkers, and bandages—items that don’t require the kind of care and maintenance that a prosthetic limb does.  The kind of coverage caps that can be placed on prostheses put many amputees in Ohio at risk for either compromised care or excessive financial strain.  The annual coverage cap in Ohio is around $4,000 while the cost of a prosthesis can run up to $40,000.
House Bill 310 does the following:
 
1.      Provides coverage for benefits for prostheses that at least equals the coverage provided under the federal Medicare program.  Prior authorization for prostheses is needed, in the same manner that prior authorization is required for any other benefit.
 
2.      Health insurers may impose a co-payment, coinsurance or both on prostheses, but it cannot exceed the copayment or coinsurance amounts imposed under part B of the Medicare fee for service program. Medicare is not considered a high reimbursement rate, so cost limits would already be imposed.
 
3.      Covered benefits are limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the enrollee’s treating physician.
 
4.      No annual or lifetime dollar maximum coverage requirements, other than the annual or lifetime dollar maximum that applies to all terms and services covered under the policy, contract, or agreement.
 
House Bill 310 will have little effect on premiums and can in fact save the state money.  Reports have been released in several states showing appropriate coverage would add only 12 cents (Iowa) to 35 cents (California) per month to insurance premiums. This translates into an annual cost to the policy holder of $1.44 on the low end and $4.20 on the high end.  Furthermore, dollars spent on rehabilitation can save money in unemployment insurance.  It is estimated that every dollar spent on rehabilitation, including prosthetics, saves more than $11 in disability benefits.  Additionally, prosthetic parity reduces the secondary conditions caused by a sedentary lifestyle, encourages less dependence on caregivers, and lowers the risk of obesity related diseases.  With proper and affordable care, amputees can continue to be contributing members of society. 
 
I think it is important to note that the population most impacted by what is being proposed in HB 310 are those who are not covered under Medicare, Medicaid or the Veterans Administration.  In other words, it is those who are working and covered under their employers insurance who lack the appropriate coverage.  Last week I had the privilege of touring Abilities in Motion, a company that makes artificial limbs.  While there, I met Ken Romp.  Ken had a leg amputated in March of 2008 and was back on the job eleven weeks later thanks to his artificial leg.  He works over 40 hours a week as a supervisor in a print factory.  Without the prosthesis, Ken would be unable to work and unable to support his family.
 
Eighteen states have adopted similar legislation to provide adequate coverage for those who have lost a limb.  I am hopeful that Ohio will do the same.