Last spring, Maryland and Virginia joined seventeen other states by passing the Prosthetic Parity Act. This important piece of legislation requires insurers to provide realistic and functional coverage for prosthetic devices.
Prior to the passage of this legislation, many insurance companies bypassed providing adequate prosthetic coverage for subscribers through the implementation of lifetime caps. Unrealistic monetary limits for lifetime care, set as low as $10,000, negatively impacted the ability for amputees to receive the prosthetics needed to regain function. With the average prosthetic costing between $7000 for a bk and 12,000 for an ak, many amputees were forced to settle for less function or had to utilize broken down or outdated devices.
Unfortunately the scope of Maryland's and Virginia's Prosthetic Parity Act is limited to insurance companies inside the state's jurisdiction. Self-insured policies are under federal jurisdiction and are currently not bound by the Prosthetic Parity Act.
It is estimated that 59% of all insured are provided coverage through a self-insured policy. The majority of large companies in the United States offer insurance to their employees through this means. Because the Parity Act does not apply to these insurance companies, many Americans are unknowingly carrying inadequate prosthetic coverage. Despite the passage of the state legislation, many amputees are left unaffected and are still under-insured concerning prosthetic care.
The ACA (Amputee Coalition of America) along with over twenty agencies and organizations, successfully lobbied Congress Parity legislation on the Federal level. On May 21, 2009, The Prosthetic & Custom Orthotic Act of 2009 (H.R. 2575) was formally introduced on the House floor. Under this legislation, all insurance companies providing for prosthetic and "custom-fabricated" orthotic devices must provide coverage equivalent to the coverage offered for medical and surgical care.
Passage of this important legislation would create an access to prosthetic devices for a large portion of the amputee community who currently find themselves under-insured. Providing adequate prosthetic insurance coverage for all insured individuals will allow the amputee to return to work, to become more physically active and increased productivity. With the passage of this law, the loop hole that keeps prosthetic care out of reach for so many insured amputees would be closed!
In the coming months Congress will be reviewing the Prosthetic Parity Act. We will keep you informed of the progress of this groundbreaking legislation.