New law requires policies to cover prosthetic limbs
Governor Mitt Romney has signed a bill that requires health plans to provide coverage for prosthetic limbs.
The law, which takes effect in January, also prohibits insurers from imposing annual spending limits specifically for artificial limbs.
Keith Cornell, a certified prosthetist and director of legislative affairs for the Massachusetts Society of Orthotists and Prosthetists, said the law aims to end ``woefully insufficient" coverage provided by some insurance plans.
``This is a tremendous relief to amputees who need this coverage," said Cornell. ``We're looking forward to seeing policies change over the next year and get people the care they really need."
The costs of prosthetic limbs vary widely. For example, an arm carries a minimum price tag of $3,000, while a body-powered above-the-knee prosthetic can cost as much as $52,000. The average cost of a prosthetic limb ranges between $10,000 and $15,000.
Proponents of the legislation said that some insurers restrict coverage of artificial limbs by imposing annual caps or limiting benefits to one limb per lifetime.
``In recent years we've seen more and more insurers reduce or eliminate their coverage" for prosthetics, said Morgan Sheets, the advocacy director for the Amputee Coalition of America, a nonprofit group based in Knoxville, Tenn.
In a recent membership survey, the ACA found that 24 percent of its members had experienced reductions in healthcare coverage for prosthetics, and 4 percent had benefits eliminated altogether.
Many people are unaware of inadequate coverage, she said, until the unthinkable occurs.
Steve Stempien is one example. Two years ago, he had no idea how much artificial limbs cost or how they were covered by his HMO insurance plan. Then, his leg became infected after surgery. The infection persisted and ultimately physicians had to amputate his left leg below the knee. When he was fitted for his prosthesis in November 2004, he expected that he would be responsible for a co payment and his HMO would cover the rest.
But he quickly learned that his health plan's $2,500 annual cap would only cover a fraction of the cost of his $15,000 prosthetic leg.
``It was a total surprise," said Stempien, 48, of Winthrop. ``I'm still paying for it."
He said he is pleased the legislation became law, and hopes his health insurer will boost the reimbursement rates for prosthetic devices to 80 percent, similar to the federal Medicare program.
Massachusetts is the fifth state to enact a law mandating prosthetic coverage. In 2001, Colorado was the first to pass a so-called ``prosthetic parity law," followed by Maine, New Hampshire, and Rhode Island. California recently passed a similar measure, which will soon become law unless the governor vetoes it, according to the Amputee Coalition of America.
Several versions of the legislation have been filed in Massachusetts during the past five years. State Representative Joyce A. Spiliotis, a Peabody Democrat, was the lead sponsor of the bill Romney signed Sept. 7.
Emily Sweeney can be reached at esweeney@globe.com. 
