WASHINGTON, D.C. – U.S. Reps. Charlie Dent (PA-15) and Robert E. Andrews (NJ-1) today introduced bipartisan legislation to ensure amputees are able to acquire coverage that meets their unique needs. The Insurance Fairness for Amputees Act, H.R. 4175, does not mandate coverage, but requires that if an insurer chooses to include coverage of custom orthotics and prosthetics in their policy, it must be on the same basis as the plan’s general medical coverage.
“Too many amputees are discovering the coverage they believed was best for their specific needs is inadequate,” said Rep. Dent. “This bipartisan legislation will promote fairness and improve their ability to receive the specialized care and treatment they require.”
“This bill provides thousands of amputees with much needed peace of mind that the coverage they require will meet the same standards as other surgical and medical benefits provided under a private health plan. This means amputees will no longer be denied coverage for a much-needed artificial limb because of arbitrary exclusions or lifetime caps in their policies,” said Rep. Andrews. “Since this bipartisan bill does not mandate coverage, it will improve care for countless Americans without adding to our debt and deficit.”
Today, diabetes is the single largest cause of amputation in the United States, followed by peripheral vascular disease and trauma. Approximately 1 in 200 U.S. citizens is an amputee, and an even larger proportion of the population suffers chronic limb impairment because of debilitating conditions such as multiple sclerosis and cerebral palsy. Additionally, numerous veterans – many of whom will eventually transition to private sector coverage – are returning from service in Afghanistan and Iraq with limb impairments. For these Americans, customized orthopedic bracing is essential to maximizing their mobility and independence.
The Insurance Fairness for Amputees Act does not mandate coverage, and costs no federal money. In essence, the legislation is a truth-in advertising provision. Amputees and those with limb-impairments sometimes find their insurance policies offer watered-down or evasively minimalistic coverage for the orthotics and prosthetics care they require. H.R. 4175 ensures these patients have the ability to acquire coverage that provides for their distinctive needs.
The Amputee Coalition, the largest patient advocacy organization on behalf of amputees in the country, has advocated the enactment of similar legislation in nineteen states. The organization fully supports H.R. 4175 as the natural next step to assure clarity about insurance coverage.