Health Plans Seek to Keep a Leg up on Profits

What - Health plans, under the gun for inflating out-of-network consumer expenses and for not paying for pre-existing illnesses, are not under fire for capping prosthetic limb expenses at $2500 to $5000 a year, while costs have risen to $3000 to $15,000, and up to $40,000 for advanced mechanical and computer-assisted prostheses.


Why - Plans say they want to keep premium costs down, but critics assert plans dupe consumers by burying caps language in small print. Health plans are struggling to maintain profits at a high level to keep their stock prices up. As of March 13, stock prices of health prices had fallen this far in month of March: Humana -40.2%, WellPoint -33.7%, UnitedHealth -21.1%, Cigna -10.4%, and Aetna -10.2%. Health plans problems include climbing medical costs, cumbersome government programs, and consumers delaying co-pays.


When - Amputees and prosthetic makers are lobbying state legislatures to mandate coverage comparable to Medicare, which pays 80% of costs.


How - Amputee proponents argue only 2 million Americans have prostheses, so overall premiums would only rise by pennies if prostheses were generously paid for, and prostheses make people more productive, active, and healthy, lowering premium costs.


Where – Eight states have passed laws mandating coverage.


Who - The Amputee Coalition of America, an advocacy group of amputees and prostheses makers, are pushing for law in Congress to mandate coverage, and Hanger Orthopedic Group, Inc., the biggest prosthetic maker in $2.5 billion industry, is big backer of lobbying effort.