On Tuesday, September 8, the Amputee Coalition was notified that the United Healthcare Policy Bulletin, dated August 2015, announced a significant change to their coverage of prosthetics. Effective October 1, 2015, United Healthcare has indicated that they will no longer cover “elevated vacuum” (also known as active suction) sockets. The language United Healthcare used in their policy bulletin appears to be taken straight from the Draft/Proposed Medicare LCD on prosthetics. Throughout the process of responding to the draft LCD, the Amputee Coalition and many others expressed our concerns that private insurance often follows Medicare’s policy lead, and now that has been proven true.
The Amputee Coalition and many others have already provided comments to the Medicare contractors and Medicare, addressing significant concerns with the LCD proposal’s elimination of coverage for elevated vacuum sockets. This change in United Healthcare’s policy is very concerning, and highlights the fact that this issue is far from over.
On September 10, the Amputee Coalition sent a letter to CMS Administrator Andy Slavitt and Deputy Administrator for Innovation and Quality and Chief Medical Officer Patrick Conway addressing this decision by United Healthcare, and we reiterated the need for CMS to rescind this proposal and contact United Healthcare about this policy and indicate that elevated vacuum systems do have sufficient clinical evidence to be provided to patients when their medical team determines it to be medically necessary.
The Amputee Coalition is working with the O&P Alliance and the American Orthotic and Prosthetic Association (AOPA) on this issue to ensure patients are able to receive an elevated vacuum socket if it’s determined to be the best option for their needs.
While we are currently only aware of this one proposed change under United Healthcare, there is the potential that other insurance companies could follow suit. We need your help to make sure we can continue our advocacy efforts and combat any proposed changes that would negatively impact amputee care.
If you’re a United Healthcare policy holder, we encourage you to write or call United Healthcare to tell them about your concerns with this proposed change. Also, be sure to keep posted to the Amputee Coalition’s https://www.amputee-coalition.org and Facebook page for more information about this and other issues affecting the limb loss community and how you can help.