A bill that would require that full coverage insurance plans in Connecticut adopt prosthetic coverage is headed to the floor of the State Senate.
The General Assembly’s Committee for Insurance and Real Estate unanimously voted in favor of the proposal, Senate Bill 376, “An Act Concerning Health Insurance Coverage for Prosthetics.”
“Arms and legs are not luxuries,” Herb Kolodny, co-founder of the Connecticut Amputee Network (CAN), said in a press release. “We are pleased that committee members understand the important protections this bill provides to amputees and their families.” CAN was formed to lobby state legislators to pass a bill to require “insurance parity for prosthetic devices,” i.e., artificial arms and legs. (Read more about that in this previous article.)
“Getting the right prosthesis for my needs is essential for keeping me active and healthy,” Kolodny said in the release. “With the C-Leg (an advanced microprocessor-controlled knee), I was able to quickly return to work — at the same job — and not become a burden on my wife and family.”
Brenda Novak, also a co-founder of CAN, lost a leg in 2008 while working in the West African country of Mali when a water tower collapsed on her. She said the C-Leg has allowed her to lead an active life because it is more stable and safer to use in a wide range of activities.
“Herb’s leg was covered by Medicare, mine—under a ‘platinum’ plan purchased on the CT Health Insurance Exchange—was subject to exclusions and coinsurance,” Novak said in the release. “My out-of-pocket cost for the leg in 2015 was $21,000.”
David Mahler, a prosthetist and CEO of New England Orthotics and Prosthetics Systems, said in his testimony to lawmakers that he can’t always provide the level of care he thinks best because of limits dictated by the insurance. That can mean providing “a prosthesis with less functionality and limiting [her] abilities.”
Bill sponsor State Sen. Ted Kennedy Jr. of Branford said in the release that the policy outlined in the bill is based on Medicare’s coverage and payment policy, which he called “reasonable, affordable, fraud-sensitive, and periodically peer-reviewed.” New Haven State Sen. Martin Looney also is a bill co-sponsor.
“This policy is easy for health plans to understand and implement because they already have networks of providers and already process these claims for their Medicare plan participants,” Kennedy said. “Connecticut remains the only state in New England that has not passed fair prosthetic insurance coverage legislation.”