Health insurers limit coverage of prosthetic limbs,
questioning their medical necessity

An estimated 2.3 million people are living with limb loss in the U.S.

That number is expected to as much as double in coming years as people age and a growing number lose limbs to diabetes, trauma and other medical problems.

Fewer than half of people with limb loss have been prescribed a prosthesis, according to a report by the AHRQ.

Plans may deny coverage for prosthetic limbs by claiming they aren't medically necessary or are experimental devices,
even though microprocessor-controlled knees like Adams' have been in use for decades.

Cain was instrumental in getting passed a 2000 Colorado law that requires insurers to cover prosthetic arms and legs at parity with Medicare,
which requires coverage with a 20% coinsurance payment.

Since that measure was enacted, about half of states have passed "insurance fairness" laws
that require prosthetic coverage on par with other covered medical services in a plan
or laws that require coverage of prostheses that enable people to do sports.

But these laws apply only to plans regulated by the state.

Over half of people with private coverage are in plans not governed by state law.

The Medicare program's 80% coverage of prosthetic limbs mirrors its coverage for other services.

Still, an October report by the Government Accountability Office found that only 30% of beneficiaries who lost a limb in 2016 received a prosthesis in the following three years.

Cost is a factor for many people.

"No matter your coverage, most people have to pay something on that device," White said.

As a result, "many people will be on a payment plan for their device," she said. Some may take out loans.

The federal Consumer Financial Protection Bureau has proposed a rule that would prohibit lenders from repossessing medical devices such as wheelchairs and prosthetic limbs if people can't repay their loans.

"It is a replacement limb," said White, whose organization has heard of several cases in which lenders have repossessed wheelchairs or prostheses.

Repossession is "literally a punishment to the individual."
cbsnews.com/news/health-insura…

DATE: December 21, 2024 at 08:01PM
SOURCE: PSYCHOLOGY TODAY

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