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| August 18, 2006 | SPECIAL EDITION |
| Breaking News for O&P Professionals | |
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Attention California Practitioners: Take Action!
The California State Senate is expected to pass Assembly Bill 2012 (Emmerson) very shortly. The legislation will then be sent to Governor Schwarzenegger.
In short, this bill requires California health plans and health insurers that offer coverage of orthotic and prosthetic devices and services to offer that coverage with annual and lifetime benefit maximums and maximum out-of-pocket costs equal to the terms and limitations of the major medical benefit. It also requires that orthotic and prosthetic benefits be covered when prescribed by a physician and surgeon or doctor of podiatric medicine acting within the scope of his/her license (i.e. the bill would eliminate caps and coverage restrictions on O&P coverage).
This is a critical piece of legislation that must be signed into law. Unfortunately, there has been some unexpected late opposition to the measure that may prompt a veto from Governor Schwarzenegger.
His office must hear from voters; consumers, practitioners, and patients. Please ask your co-workers, patients, family and friends to send letters, e-mails, and phone calls in support of AB 2012. Please forward this message on to all of your contacts. It is imperative that letters be faxed, e-mails sent, and phone calls made in support of this legislation AS SOON AS POSSIBLE. Those wanting to fax a letter directly to the Governor can do so at: (916) 445-4633.
Those who prefer to call can do so by calling the Governor’s office at (916) 445-2841. However, expect to maneuver through a phone tree. If you do call, state that you are in support of AB 2012 at the beginning of your voice mail.
The quickest way to indicate your support for the bill is to send an e-mail today—tomorrow may be too late. To send an e-mail in support of AB 2012, visit http://www.govmail.ca.gov and click on the "supporting" button. In the "choose your subject" pull-down menu, choose "other" and it will give you a subject line where you can enter AB 2012 as your subject.
Below is an example letter/e-mail that you can use. Please note, adding your personal experience with O&P caps and coverage restrictions is always more powerful than form letters:
Dear Governor Schwarzenegger:
A disturbing trend in the private market for insurance is leaving amputees and persons recovering from surgery or disease with annual caps as low as $2,000 per year for both O&P and DME coverage combined. Unfortunately this means that many patients are left with zero coverage by the time they leave the hospital and are in need of a device to replace a limb or support ongoing treatment.
Children who outgrow their devices are especially hard hit because they may need a series of devices to correct deformities or treat progressive diseases. Policy holders who have fairly paid premiums and had thought that coverage for medically necessary devices was included are shocked when they receive the news that they will not receive the care necessary to treat many common diseases or recover from surgery.
Lack of coverage impacts families in a drastic way. Denying a young amputee an artificial limb to replace one that has been outgrown after treatment for cancer or injury is simply inhumane. Condemning an elderly patient to a wheelchair who could otherwise be mobile is financially and morally irresponsible. Although patients requiring orthotic or prosthetic services are a small minority of insured Californians, coverage for these services is absolutely critical to any insured Californian. Full coverage for these devices must be separated from the DME category and treated like breast replacement devices, with no discriminatory caps or co-pay requirements.
A disturbing trend in the private market for insurance is leaving amputees and persons recovering from surgery or disease with annual caps as low as $2,000 per year for both O&P and DME coverage combined. Unfortunately this means that many patients are left with zero coverage by the time they leave the hospital and are in need of a device to replace a limb or support ongoing treatment.
Children who outgrow their devices are especially hard hit because they may need a series of devices to correct deformities or treat progressive diseases. Policy holders who have fairly paid premiums and had thought that coverage for medically necessary devices was included are shocked when they receive the news that they will not receive the care necessary to treat many common diseases or recover from surgery.
Lack of coverage impacts families in a drastic way. Denying a young amputee an artificial limb to replace one that has been outgrown after treatment for cancer or injury is simply inhumane. Condemning an elderly patient to a wheelchair who could otherwise be mobile is financially and morally irresponsible. Although patients requiring orthotic or prosthetic services are a small minority of insured Californians, coverage for these services is absolutely critical to any insured Californian. Full coverage for these devices must be separated from the DME category and treated like breast replacement devices, with no discriminatory caps or co-pay requirements.
Questions concerning the bill or ways you can help ensure its passage? Call Sherry Daley at the California Orthotic & Prosthetic Association (COPA) at (209) 744-2672 or Walter Gorski at the American Orthotic & Prosthetic Association (AOPA) at (571) 431-0809.
AOPA thanks you for your support of this important legislation.