advocacy in action S Arms and Legs Are Not a Luxury We Need Your Help! Summer is now in full swing, and there couldn’t be a better time for you to make a difference and have a positive impact for amputees throughout the United States. Regardless of what you may think about the Affordable Care Act (AKA “Obamacare”), the fact remains that it is an integral part of the healthcare system we currently operate under. With that in mind, there is a major issue impacting amputees regarding the implementation of the Affordable Care Act that we need your help to change. In 2010, when the law was passed, several members of Congress expressed their intent to include prosthetic and custom orthotic devices in the Essential Health Benefits required by the law. Unfortunately, while every state has at least some level of coverage for prosthetic devices, very few states explicitly included prosthetic devices in their Essential Health Benefits. 8 inMotion Volume 24, Issue 4 July | August 2014 by Dan Ignaszewski Why does this matter? While insurance companies cannot put an annual or lifetime dollar limit on the overall plan, they can continue to put an annual dollar limit and a lifetime dollar limit on spending for healthcare services that are not considered “essential.” Therefore, because most states did not explicitly include prosthetic devices in their Essential Health Benefits, insurance plans can still put an annual dollar limit and/or a lifetime dollar limit on spending for those devices. This means that many states still allow or have limits on coverage, such as in the New York exchange for example, where all of the plans offered under the insurance exchange have a restriction of “one limb per lifetime.” There are other states that restrict the dollar amount for devices, and some states where their insurance exchange plans exclude things such as “bionic,” “biomechanical,” “robotic,” “power-assisted limbs” or “computerized” devices.
To see the actual publication please follow the link above