Pennsylvania Commits to Protecting Coverage

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By Morgan Sheets

A bill calling for equity of prosthetic coverage in health insurance policies was the focus of a public hearing held by the Pennsylvania House Health and Human Services Committee on Thursday, October 19. The hearing was chaired by Rep. Fred McIlhattan.

"Individuals who have undergone some type of amputation, such as an arm, leg, hand or foot, and children who are born with limb loss or difference, face many obstacles in their recovery and in their daily routines," McIlhattan said. "Not being able to pay for limb replacement to return to work or lead productive lives shouldn't be among them. This hearing was held to determine whether state law should reflect uniformity in the healthcare coverage for the cost of prosthetics as well as repair and necessary therapy."

Under House Bill 2718, health insurance plans would cover the fitting and repair or replacement of a prosthetic device and/or component if determined to be medically necessary by the prescribing physician. Currently, coverage varies among health insurance companies which sometimes evaluate coverage on a case-by-case basis.

In a recent statewide survey, the Amputee Coalition of American (ACA) found at least eight different companies in Pennsylvania that are restricting or eliminating coverage for prosthetics. The restrictions vary from financial caps of $1,000 or $2,500 to limiting a person's benefit to one prosthesis per lifetime. Representative McIlhattan and the primary bill sponsor, Rep. Bernie O'Neill, committed to passing HB 2718 in 2007.

In other news, several other states have stepped forward to express interest in launching an initiative. The ACA has met with individuals and groups from Michigan, Ohio, Alabama, and Utah over the past month to talk about building state campaigns.

With three new laws on the books and a strong showing of support across the country, we are confident that 2007 will be a very successful year.

Morgan Sheets is the national advocacy director for ACAs APPLL initiative. She can be reached at APPLL@amputee-coalition.org