Iowa Bill Would Lift Insurance Caps on Prosthetics

Brent Soderstrum, who lost his leg in a car accident about seven years ago, is backing a bill that would bar insurance caps on prosthetics.

The Des Moines attorney found out about 1 1/2 years ago that his insurance company would pay only half of what it would cost to fit him with an artificial leg. So, he spent nearly $5,000 for the prosthetic leg that fits just above his knee, while his insurance paid only $2,500.

“This bill is about what insurance should cover,” he said of the proposal, which has already passed the Iowa Senate and waits on a list of unfinished bills in the House.

He is getting help pushing the legislation from representatives of Clive-based American Prosthetics & Orthotics Inc.

There are opponents who argue that 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.

Advocates say the increases in insurance costs would be minimal.

Insurance agreements capping payments for artificial limbs became widespread about four years ago. Since then, five states have passed legislation that requires the companies to cover prosthetic care to the same extent Medicare does, according to information from the Iowa prosthetic company.

“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.

Rep. Linda Upmeyer, R-Garner, has offered a revision to the proposal that calls for a yearlong study to see whether the mandate is needed. The state would pick up the cost for people who don’t have coverage during that time.

“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?