Legislative Information

The cost of prosthetics varies significantly and as technology improves, the cost is increasing. The cost of the typical prosthetic device ranges from $5,000 to $30,000. Due to wear and changes in the limb, prosthetic devices require replacement for an adult every three to five years and for a child every six to nine months. The use of prosthetics allows individuals with the loss of a limb to perform the normal functions of daily living. A large percentage of individuals with limb loss (70% to 90%8) are able to return to work and function in their home environment. Because prosthetics allow an individual to perform activities for themselves and have more control over their lives, it helps people deal with the psychological trauma of limb loss. Where Can We Go From Here? The best possible means of ensuring that Virginia amputees receive fair and reasonable treatment from their health insurance companies is to convince Virginia lawmakers that they need to pass a mandated prosthetic insurance benefit.

Legislative Action and Prosthetic Insurance in Virginia

 

The Problem - Inadequate Prosthetic Coverage: An alarming trend in recent years has been the health insurance industry?s move to reduce their coverage of prosthetic devices. Many insurers have placed restrictive annual or lifetime caps on prosthetic coverage and some have even eliminated it entirely. Most consumers are totally unaware of this as it is reasonable to assume that any major medical health policy would cover prosthetic care the same as they would cancer, heart attack or any other catastrophic accident or illness.

The Solution - Mandated Coverage: So far, many insurance companies have left amputee consumers little choice other than to seek legislative relief from unfair or discriminatory practices. State governments can force insurance companies to offer fair and equitable coverage by passing a mandate. As of this writing, 19 states have now passed prosthetic insurance legislation and many more are at some level of consideration.

In the spring of 2006, Senator Patricia Ticer and the Amputee Coalition of America met with Virginia Prosthetics and Orthotics and asked if we would lead a campaign to support a prosthetic parity bill that Sen. Ticer would sponsor. We agreed and began a three year effort to make prosthetic parity a reality in Virginia.

Though we were successful in finally getting a prosthetic insurance bill passed in Virginia, we did not get what we had hoped for. Virginia is very adverse to insurance mandates. In their desire to protect business interests, many legislators have adopted tunnel vision when it comes to discussing a mandate. They ignore the supporting facts as presented by their own state review commission which found that the cost to consumers would be negligible and that both the state and most likely the insurance companies themselves would save money over time. To see reports from Virginia and other states go to the Amputee Coalition of America’s advocacy info site here. ??

We had asked the General Assembly to pass a mandated benefit bill, but in the last few days of a three year battle, we had to accept a mandated offer. The health insurance industry’s lobbyist had spared no expense in fighting this legislation by misrepresenting the facts and calling in favors purchased with campaign donations. In the end, key legislators made it clear that the only thing they would accept was a mandated offer.?

The bill took effect on January 1, 2010 and it will be up to each and every one who supports it to see that it is adhered to by the health insurance companies doing business in Virginia. To see how, just refer to our section; “ Who Will Protect My Rights as an Amputee”

 

What is the difference between a mandated benefit and a mandated offer?

 

Put simply, in the case of the prosthetic insurance issue;

A mandated benefit would state language similar to “any health insurance company proposing to issue individual or group accident and sickness insurance policies shall provide coverage for the cost of prosthetic devices and components.”?

A mandated offer however, would state “any health insurance company proposing to issue individual or group accident and sickness insurance policies shall offer and make available coverage for the cost of prosthetic devices and components.”?

Who will protect my rights as an amputee?

In Virginia, Insurance is regulated by the State Corporation Commission’s Bureau of Insurance or BOI. One of their main concerns is consumer awareness and protection. The Bureau makes available a wide range of consumer guides and materials to help you better understand the policy you have purchased or are about to purchase as well as explaining about various health insurance coverages.

Virginia Bureau of Insurance information package containing: ?Consumer Health Insurance Guide and a Consumer Complaint Guide including a complaint form.

When consumers are unable to reach a satisfactory resolution to a problem after having first tried their insurance agent and or their insurance company, then they can contact the BOI for assistance. To obtain more information go to the BOI website HERE

 

What Can I Do To Help Ensure That Insurance Companies Comply?

 

Now that Virginia has passed its first prosthetic parity bill, everyone will be watching to see what happens. Some companies that already provide adequate prosthetic coverage may not make any changes, some companies that now have caps may simply remove these caps in order to remain competitive in the market. However, some companies which currently have caps may decide to offer a prosthetic rider at an additional premium.?


There have been instances in other states that have passed prosthetic parity bills where insurance companies have ignored or even denied coverage. Unless consumers make their state governments aware of these situations, some insurance companies may try to circumvent the law. If you experience a denial or excessive limit, contact your insurance company and challenge their decision. If you are still not satisfied that you are being treated fairly, contact the Virginia Bureau of Insurance.


The Virginia Orthotic and Prosthetic Association would like to compile a database of current prosthetic insurance costs so that we can provide a list to our patients when choosing their health insurance. V.O.P.A. would also like to know about any problems that amputees are having, so please contact us with any policy rate information or problems with insurance companies that you would like to share. Call or e-mail Charlie Coulter at 540-525-0500 / ccoulter@virginiaprosthetics.com

 

Where Can We Go From Here?

 

The Virginia General Assembly is one of only two state legislatures that has chosen to pass an offer rather than a benefit. Though Congress is considering some form of Federal health care, no one really knows what will be covered, to what extent it will be covered, or when it will be covered.

The best possible means of ensuring that Virginia amputees receive fair and reasonable treatment from their health insurance companies is to convince Virginia lawmakers that they need to pass a mandated prosthetic insurance benefit.

Review the information contained on the ACA?s advocacy site so that you know the facts.?
Contact your state representatives and let them know that this is an important issue.
Make them aware of the following:

Tell them that Virginia and California are the only two states that passed an offer rather than a benefit. Considering their state?s financial situation, do we really want to emulate California?

Remind them that our own Mandated Benefits Review Commission reported that this mandated benefit would have minimal impact on small business or individual consumers and that it would probably save the state millions in health, rehab, and social services costs. Because of this, the commission made one of the only favorable recommendations since the commission was formed.

 

Then ask them if they will support a Mandated Benefit and if not, ask them why?

Mandated Benefit

Arkansas
Colorado
Utah
New Hampshire
Oregon
Rhode Island
Maine
New Jersey
Vermont
Mississippi
Illinois
Indiana
Massachusetts
Iowa
Louisiana
Indiana
Maryland
Texas

Mandated Offer

California
Virginia