I have been asked my many people what I discovered from my post a couple weeks ago regarding O&P Coverage under the new Healthcare Reform law.
I did not get any clear, 100% complete answer on this matter. I did get many emails with good information, and many emails from others who are also worried and frustrated over this new law that was signed several months ago.
One thing that is 100% clear and accurate is that O&P coverage is NOT a guarantee or specifically included as covered services. No place in the bill mentions that O&P is covered.
A few emails from leaders in this field (or who work for organizations of this field) commented that they ARE covered, BUT they are still lobbying hard to get them covered and included. They claim they are covered, under the assumption that these fall in to a category of rehabilitative of habilitative services. But, O&P is NOT mentioned specifically.
It was also pointed out that in the congressional healthcare bill, O&P was mentioned specifically as medically necessary and covered benefits. But the Senate Finance bill (Baucus Bill) is what was basically passed and signed into law, and that O&P was stripped from the language.
The bottom line is that it appears that there is active lobbying going on for O&P coverage under this reform bill, which tells me that basically nobody truly believes that O&P is really a covered service or benefit starting January 1, 2014.
As an amputee, this really concerns me, because we all know that private healthcare insurance is going to also follow this reform bill, which will cut off prosthetic services. Even though I make my own legs, where will I even be able to get the components if this field basically shuts down if there is no funding.
As a practitioner and professional in this field, well….I am sure there are other jobs out there. And, hopefully I will be able to afford a trip to Germany or Iceland to find components and materials.
I hate to sound all gloom and doom about this, but this is actually what is written and signed into law. IF O&P were really still covered and included, then why are our organizations still lobbying for this?
This goes along the lines of the author of this bill, and her views and ideas. Max Baucus wrote the bill (yeah “wrote” the bill, and called is the Baucus bill). But a few months ago he was asked if he had even read the bill, which he replied that he had NOT read the bill. He admits that he had a chief of staff who was most instrumental in writing it, and an entire staff of people that worked on it, and they presented it to him, told him what was basically in it, and he approves it, and he still stands behind it.
Anyone can google his staff, and especially his Chief of Staff. Her name is Elizabeth Fowler, or “Liz” Fowler. He real job is/was the Vice President of External Affairs of Anthem/Wellpoint. We all know that Anthem will do about anything to NOT pay for prosthetics today, and so with this new law passed, they won’t have to worry about that anymore. Nobody will be required to pay for O&P.
I know this is a simple view of a complex issue, but we all need to wake up, tell EVERYONE about O&P coverage.
I first learned about this on vacation at Disneyworld when someone in a line told me about this reform bill and O&P. I was able to check this out while I was there, and from what I could find, he was right. And it still seems to be that he is still right.
We need to tell neighbors, friends, and everyone about this lack of benefits for even the simple and basic prosthetic coverage for amputees. Make this a very public issue for everyone….it is amazing to see someone’s jaw drop when you tell them that this healthcare change means that O&P is NOT covered anymore. Challenge them to read the bill, use the search engine for it, and see IF you can find anywhere that states O&P are covered.
So, that’s what I have learned from my posting on here last week….and I am passing this along.
We need to get this fixed….either repeal this bill totally and start over, or get this fixed. How??? I don’t know for sure. But with the author of this bill being a big-shot Anthem person, I don’t know that it can be fixed to really benefit the people….
Thanks
Jim DeWees, CP
