Prosthetic Device Manufacturers, Users Push For Higher Coverage Payments

Main Category: Medical Devices / Diagnostics
Also Included In: Health Insurance / Medical Insurance
Article Date: 12 Mar 2008 - 8:00 PDT

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Amputees and manufacturers of prosthetic limbs are urging lawmakers in several states to introduce legislation that would require private insurance companies to provide prosthesis coverage similar to that of Medicare, the Wall Street Journal reports. Eight states currently have laws mandating prosthesis coverage similar to Medicare, and 27 other states are considering similar legislation. The Amputee Coalition of America is lobbying to introduce a bill in Congress.

Medicare covers at least 80% of the cost of prostheses and allows "regular replacement," generally every five years, according to the Journal. However, the Journal reports that Medicare also covers computer-assisted artificial limbs. As technological advancements have caused manufacturing and sales costs of the devices to rise, many health insurers have placed coverage limits on prosthetic devices of $2,500 or $5,000 annually or restricted coverage to just one device per recipient in a lifetime. The cost for regular prosthetic limbs can range between $3,000 and $15,000, and costs can reach as high as $40,000 for more technologically advanced or aided devices. According to the Journal, prosthetic devices "are among the biggest-ticket items" affected by health insurers' and employers' efforts to contain rising health costs.

The Journal reports that supporters of mandates say the additional coverage would "cost just pennies in monthly premium increases" and also encourage recipients of the limbs to be active and avoid other costly medical services and issues related to back problems or obesity.

Health plans believe a prosthesis coverage mandate would prevent consumers and small-business owners from being able to purchase health plans that are less expensive and do not have unnecessary benefits. Mohit Ghose, a spokesperson for America's Health Insurance Plans, said, "The issue isn't the merits of any single mandate," adding, "It's what mandates collectively do to the affordability of health insurance" (Fuhrmans, Wall Street Journal, 3/11).

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