Prosthetic parity – what is it?

Parity is a buzzword that means “level with” or “equal to”. Legislative parity is the attempt through either the state or federal legislative process to seek equalization. One of the most appropriate and logical applications of legislative parity is in Heath Care, in particular health insurance coverage. Legislative equality in health care means adopting legislation that equalises insurance benefits.

So, again, what is prosthetic parity? It is state or federal law that requires insurance companies to pay for prosthetic devices at the level of federal programs, payment rules and regulations. Federal programs can be Medicare, Medicaid, or programs like the Federal Personnel Insurance held by Congress and other government employees. These programs provide compensation without capitation or exemption for medically necessary services such as dentures.

Why is legislation needed? For all private insurances are not created equal. While many insurance companies pay for prostheses without extensive requirements, there is a growing trend across the United States that shows that private insurance companies significantly reduce prosthesis benefits or eliminate prosthesis protection. The most notable change in prosthetic protection is the “insurance ceiling”. Simply put, an “insurance ceiling” is a maximum annual or lifetime contribution. “Cap” is a common method used to limit coverage, which reduces the company’s financial obligation and payout, but still allows the company to claim the benefit.

Annual protest service ceilings range from $ 500 to $ 3,000.00 and lifetime restrictions range from $ 10,000.00 for a prosthetic device during a person’s lifetime (from birth to death). In a recent survey of the 20 major insurance companies, the number of insurers with financial ceilings, exclusions or unusually high deductibles increased by 100% over a six-year period from 2000 to 2006. All 20 surveyed insurance companies had introduced financial ceilings for prosthetic protection.

An explanation of cost.These “caps” are so important because a lower extremity prosthesis can range in cost from $ 5,000.00 to $ 50,000. An upper extremity device or arm can range from $ 3,000.00 to $ 30,000. Why the difference and why not just give everyone the cheaper the variants? The cost does not define medical suitability. An amputee’s daily activities, occupation, and certain health factors determine the specific materials and technologies used for each custom-made device. As an example, the same medication is not suitable for all people with diabetes and not everyone gets the same painkillers after the operation.

Who influences this? Amputation is a catastrophic event. There is no cure. Amputation is a lifelong condition that does not go away. Fortunately, the limitations of limb loss can be overcome through medical skills training and the latest technical advances.

There are an estimated 1.9 million amputees in the United States and approximately 185,000 amputation surgeries are performed each year. Of these amputations, 82% are due to peripheral vascular disease and diabetes. However, there are other causes of amputation. Approximately 8,900 children are amputated each year due to lawnmower accidents. Birth defects lead to a lifelong need for prostheses. In February 2007, 897 US Armed Forces personnel were in need of prostheses.

Benefits of parity legislation. Simply put, the insurance protects against catastrophic events. These are the expectations when buying an insurance policy. However, it has become increasingly clear that legislation is necessary to ensure prosthetic protection and fair payment rules. Individuals who pay for insurance through premiums should receive appropriate and medically necessary treatment: their arms and legs. Prostheses provide dignity and self-confidence. Prostheses put people back to work. In addition, by returning amputees to the workforce, strengthening society and its economy.

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