Concern About Cuts In Insurance Coverage for Prostheses

November 2, 2015

Last week, Surgeo Blog shed light on the Federal government's seemingly slippery slope to cuts in insurance benefit coverage for patients who needed limb prosthetics. The post framed the subject in light of its decision last year to no longer cover vacuum erection devices, a common treatment for erectile dysfunction. The question was what happens to patients if it stops paying for penile prostheses? That post may have been focused on a specific type of prosthesis, but this is a generic, generalizable question that applies to artificial hands, knees, hips, shoulders, vertebral discs, urinary sphincters ... it's a long list of prostheses that could be affected by roll back of coverage.

It would seem that the question of what happens to patients if coverage for prostheses is eliminated is on many people's minds. The question is filtering down to the grass roots and causing deep concern. A recent television story by a Baltimore ABC affiliate it was reported recently that over 100,000 people signed a petition in just 30 days that was sent to Medicare to ask it to maintain coverage for prostheses. At issue is the idea that "one size fits all" and that every patient should have to take the same prosthesis. The article cites the utility of choice of prostheses and how one leg amputee says coverage changes that would restrict choice would adversely affect him. Surgeo Blog covered the clinical importance of choice in a recent post about malleable penile prostheses.

The proposed changes in coverage determination at the local level, which is how such changes are implemented, has stirred the focused attention and organized feedback of the Amputee Coalition and its advocacy partners. You can read their open response letter if you click here. In brief, like the television story, they are expressing deep concerns about how physical impairments that can only be overcome with prostheses will be addressed if the government -- and follow-on third parties -- decide to restrict coverage for prostheses.

As of this writing, Surgeo Blog is not aware of any actual changes to coverage for any prosthesis: limb, knee, penile, or other. We will continue to monitor coverage and report as things develop. In the meantime, we invite you to keep us informed of any such changes by writing to us using this contact form.

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