Hanger Orthopedic Group is one of the partners supporting the Amputee Coalition of America (ACA) Action Plan for People with Limb Loss (APPLL).
Hanger's chief medical officer, John J. Rush, MD, spearheads Hanger's advocacy efforts for prosthetic parity legislation.
The ACA defines prosthetic parity as: "insurance companies covering appropriate prosthetic care."
Legislation has been passed in six states: Colorado, Maine, New Hampshire, Rhode Island, Massachusetts, and California. Rush said that about 20 additional states have some form of prosthetic parity efforts underway.
"We encourage Hanger employees and patient advocates to attend hearings and to call upon their legislators and state governors to pass and sign these bills into law," Rush said. "Parity legislation is very simple. The legislation defines a prosthesis as anything that replaces a whole or a part of an arm or leg' and requires this to be covered by insurance companies. Bills include provisions that these companies shall not impose any annual or lifetime dollar maximums. Insurance companies can require a reasonable co-pay up to 20 percent, or up to 40 percent if the insured individual goes out of the insurer's provider network. Insurance companies can also require prior authorization." Rush added, "We believe this legislation is very good for the amputee community, including our patients."
Question from The O&P EDGE: Some people have criticized parity legislation for not requiring provider qualifications. Others have pointed out that these are two separate issues and would only serve to confuse legislators. What is your thinking on this?
Answer: "We have encouraged people not to confuse the issue of parity with the issue of licensure. Every time you introduce something new into legislation, it just complicates the bill, opens that bill up to more attacks from other sides, and lessens your chances of getting it passed."
Licensure
However, Hanger does support licensure, Rush said.
Regarding licensure, Hanger Chairman and CEO Ivan R. Sabel, CPO, added a caveat: "As a certified practitioner and former president of ABC, I can tell you that I believe in licensure when it is being used as it was intended: as a quality assurance standard for patients. But when licensure is used to keep competition out of a particular state, that's not healthy for our profession. Unfortunately, there have been a couple of cases where licensure bureaus, or in some cases, the legislation itself, have been designed as a sort of turf protection as opposed to a validation of competency. I support licensure when the intent is for patient protection."
For more information about the ACA APPLL and other partnering companies, visit amputee-coalition.org/aca_advocacy.html
