Global Courant
Parity is a buzzword meaning ‘equal to’ or ‘equal to’. Legislative parity is the attempt to pursue equality through the legislative process of the state or federal government. One of the most appropriate and logical uses of legislative parity is in healthcare, especially health insurance. Legislative parity in health care means passing legislation that equalizes insurance benefits.
So again, what is prosthetic parity? It is state or federal law that requires insurance companies to pay for prosthetic devices on par with federal programs, payment rules, and regulations. Federal program can be Medicare, Medicaid, or programs such as Federal Employee Insurance which is administered by Congress and other government employees. These programs offer reimbursement without a principal or exclusions for medically necessary services such as prosthetics.
Why is legislation necessary? Because not all private insurance is created equal. While many insurance policies cover prosthetics without comprehensive requirements, there is a growing trend in the US that shows private insurance companies significantly reducing reimbursements for prosthetics or eliminating prosthetics coverage. The most notable change in denture coverage is the “insurance cap.” Simply put, an insurance cap is an annual or lifetime benefit. The “cap” is a common method used to limit coverage, reducing the company’s financial obligation and payout, but still allowing the company to claim the benefit.
Annual limits on prosthetic services range from $500 to $3,000.00 and lifetime limits range from $10,000.00 to one prosthetic device during a person’s lifetime (from birth to death). In a recent survey of the 20 major insurance insurers, the number of insurers with financial limits, exclusions or unusually high deductibles increased by 100% in a six-year period from 2000 to 2006. All 20 insurers surveyed had introduced financial limits for coverage of prosthetics.
An explanation of the costs.These ‘caps’ are so important because a lower extremity prosthesis can range in price 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 version? Cost does not determine medical eligibility. An amputee’s daily activities, occupation, and certain health factors dictate the specific materials and technologies used for each custom device. For example, the same medication is not suitable for every person with diabetes, nor is everyone given the same painkiller after surgery.
Who has this effect? Amputation is a catastrophic event. There is no medicine. Amputation is a lifelong condition that does not go away. Fortunately, through medical skills training and recent advances in technology, the limitations of limb loss can be overcome.
There are an estimated 1.9 million amputees in the United States and approximately 185,000 amputations are performed each year. Of those amputations performed, 82% are due to peripheral vascular disease and diabetes. However, there are other causes of amputation. Each year, approximately 8,900 children are amputated as a result of lawnmower accidents. Birth defects result in a lifelong need for prosthetics. As of February 2007, 897 US armed forces required prosthetics.
Benefits of parity law. Simply put, insurance protects against catastrophic events. That is the expectation when taking out an insurance policy. However, it is becoming increasingly clear that legislation is needed to ensure denture coverage and fair payment rules. Individuals who pay for their insurance through premiums must receive appropriate and medically necessary treatment: their arms and legs. Prostheses provide dignity and self-reliance. Prosthetics put people back to work. In addition, by returning amputees to the workforce, you strengthen a community and its economy.
Prosthetic parity – what is it?
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