Caps on insurance coverage for prosthetics are targeted

A mandate included in a bill before the House could increase premiums, critics say.
By JASON CLAYWORTH REGISTER STAFF WRITER
April 23, 2007

Brent Soderstrum found out about 1 1/2 years ago that his insurance would pay only half of what it would cost to fit him with an artificial leg.The insurer, like many others across the nation, had placed an annual limit on payments for prosthetics.Soderstrum, who lost his right leg in a car accident about seven years ago, spent almost $5,000 for the prosthetic leg that fits just above his knee. His insurance company paid $2,500. He was lucky - some prosthetics cost $30,000 or more.Soderstrum, an attorney for a Des Moines law firm, said the issue isn't about his personal costs. He's fighting for other Iowans. "This bill is about what insurance should cover," he said.Now, Soderstrum and others, including representatives from American Prosthetics & Orthotics Inc., are pushing Iowa lawmakers to pass a bill that bars such insurance caps.The proposal, Senate File 508, has already passed the Senate and is on a list of unfinished bills in the House.Opponents say the mandated coverage could increase insurance premiums."They create added costs to the policies that small businesses have to buy," said John Gilliland, a lobbyist for the Iowa Association of Business and Industry.The caps for artificial limbs became widespread in insurance agreements about four years ago. Since then, Colorado, California, Maine, New Hampshire, Rhode Island and Massachusetts have passed legislation that requires companies to cover prosthetic care to the same extent that Medicare does, according to information from the Iowa prosthetic company.Rep. Linda Upmeyer, a Republican from Garner, has offered a revision to the proposal that calls for a yearlong study to see whether the mandate is needed. In the meantime, the state would pick up the cost for people who don't have coverage."One of the things that worries me a little bit, the people really pushing this bill forward are the people who are making prosthetics," Upmeyer said. "Do we really have an issue here, or are we trying to sell more prosthetics?Advocates say the increases in insurance costs would be minimal. Colorado lawmakers, for example, estimated their law would increase premiums by 12 cents per person per month for residents with health insurance."This is coverage Iowans used to have in their health coverage, and that coverage has been taken away," said Rod Cheney, president of the Iowa Prosthetic, Orthotic and Pedorthic Association.Large businesses are often self-insured, which means they would be exempt from the mandate. Small businesses would be most directly affected, said Paula Dierenfeld, executive director of the Federation of Iowa Insurers. Small businesses currently can choose the level of coverage they desire."What I can tell you is all mandates increase premium costs. It almost goes without saying," Dierenfeld said. "By imposing the mandate, you would take choice away from businesses."Reporter Jason Clayworth can be reached at (515) 699-7058 or jclayworth@dmreg.com