PA House Holds Parity Bill Public Hearing

A bill calling for equity for prosthetic coverage in health insurance policies was the focus of a public hearing held by the Pennsylvania House of Representatives Health and Human Services Committee, chaired by Rep. Fred McIlhattan (R-Clarion/Armstrong). The legislation is designed to affect people with limb loss who are currently insured and would guarantee that unfair and inequitable exclusions, caps, and restrictions could not be imposed by insurance companies, said Morgan Sheets national campaign director for the Amputee Coalition of America (ACA) Action Plan for People with Limb Loss (APPLL).

"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 that sometimes evaluate coverage on a case-by-case basis, Sheets explained.

In a recent statewide survey, the Amputee Coalition of America (ACA) found at least eight different companies in Pennsylvania that are restricting or eliminating coverage for prosthetics, Sheets said. The restrictions vary from financial caps of $1,000 or $2,500 to limiting a person's benefit to one prosthesis per lifetime.

"Although some major health insurance plans pick up partial cost for members who need artificial limbs, many do not," Sheets said. "This legislation would set a standard for insurance coverage across the Commonwealth and would eliminate unfair restrictions in order to ensure appropriate coverage for all amputees. Individuals would still be responsible for co-payments, co-insurance, or deductibles. To date, six states have already passed similar legislation and at least 18 others are working toward the same."

"It's very shocking and heartbreaking for people who have already suffered the trauma of limb loss to find out that their insurance carrier will pay only on a very limited basis or not at all when it's time to be fit for a prosthetic limb," said amputee and ACA Board member Kathy Spozio.

An ardent advocate for people with disabilities, Spozio serves on the Pennsylvania Campaign Committee to advocate for insurance parity.

"Working with Representative McIlhattan on this important legislation has been rewarding for me both personally and as a constituent of the 63rd District," Spozio said. "Representative McIlhattan's professionalism and compassion in addressing this much needed legislation makes me proud to have him represent me in Harrisburg." McIlhattan is a co-sponsor of the bill.

Among those providing testimony at the hearings were Michael and Sean Brame of York County. "Sean is a fifth-grader who lost both legs, an arm, and a part of his other hand to a blood infection resulting from a broken ankle," said Sheets. "Sean faces a lifetime of bills for prosthetic devices, fittings, and therapy. The tally for his prosthetic fittings, sockets, legs, ankles, socks, liners, etc. has reached well over $50,000 already. Even though his family's insurance now covers a large portion of the cost, his parents worry that Sean will not have that benefit when he finishes college and enters adulthood."

"Sean's story greatly inspired me," McIlhattan said. "This is a young man with a zeal for life who sees his artificial limbs as an inconvenience rather than a disability. This legislation would ensure that others like him are treated fairly by insurance companies and are given a chance to succeed in their lives."

"This is not only smart policy, it is the right thing to do," said Garry Moore, a local amputee and parent, in his testimony to the committee.

Also testifying at the hearing were Sheets; amputees from the Berks County Chapter of Amputee Support Team; and John Rush, MD, chief medical officer for Hanger Orthopedic Group Inc., Bethesda, Maryland.

McIlhattan said he believes the law needs to be changed so that there is more uniformity in regards to prosthetic coverage, according to Sheets. "His goal in co-sponsoring the bill is to allow amputees to live their lives to the fullest, whether it is earning a living for themselves and their families or experiencing the everyday joys of life that are so often taken for granted."

PA House Holds Parity Bill Public Hearing

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PA House Holds Parity Bill Public Hearing

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O&P JOBS

HH Manager, Orthotics & Prosthetics

Orthotics and Prosthetics Assistant

Certified Orthotist — Full-Time or Part-Time, Pediatric Practice

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