Colorado Mandatory Prosthetic Coverage
Tony Barr
Description
Collection
Title:
Colorado Mandatory Prosthetic Coverage
Creator:
Tony Barr
Date:
9/24/2001
Text:
During my attendance at the ACA meeting in June one particularly interesting presentation was provided by the founder of the Colorado Coalition of Working Amputees, Jeff Cain, MD,and B/K amputee that discovered he had no coverage for prosthetics.Below this message is our recent corrospondence.
His group,CCWA, was successful in passing state legislation to mandate insurance companies in the state to provide prosthetic coverage to all working individuals in the state even though the Colorado presently has no state O&P regulation.
Below are my comments to him. Jeff is enthusiastic and wants to actively expand his insurance reform bill to other states and perhaps at a national level.
Perhaps a consumer/profession effort in the licensed states could begin a grass roots effort initiative with their model legislation.
Perhaps the NEW Academy leadership may have an interest in participating actively supporting on a state level (prioritizing states with O&P regulation) and at the national level? It seems apparent to me that support and enthusiasm to regulation efforts may be accelerated if O&P insurance coverage was mandated for our perspective states and those not yet regulated.
Feel free to contact Jeff who is very responsive to help in expanding prosthetic insurance reform to other states.
Let me know your thoughts.
Tony Barr
----- Original Message -----
From: Tony Barr
To: <Email Address Redacted>
Sent: Sunday, June 24, 2001 10:00 AM
Subject: Re: Prosthetic Insurance Reform
Hello Jeff, It was also nice to meet with you and share mutual inspirations and goals.
Agitate is certainly the proper word for gaining support for expansion of such reform!
The accomplishment that you and your group have generated in Colorado is commendable.
However, I fear that it will be short lived without mandating minimum provider education qualifications i.e.. regulation of the profession.I it is just a matter of time before providers whom are not qualified to provide O&P services will bill an insurance company for shoddy work.You cannot, for long ,mandate insurance coverages when unqualified providers are performing the services.
What other legitimate health care profession does not require a license to provide that service?
The only consumer complaint mechanism, in most unregulated states, is the Consumers Affairs Dept. which is buried under the State's Department of Agriculture.
The opposition to O&P regulation have cited the lack of documentation of consumers complaints to reason there is no need of establishing provider criteria and regulating the industry.
Perhaps the State of Colorado's Insurance Commission will oversee the new legislation?
Now that insurance providers in Colorado are required to provide O&P coverage, the large chains,Hanger O&P (632 facilities in the US) will, most likely, be able to provide the lowest bids for such services perhaps driving the qualified independent provider out of business. This is probably why they (Hanger) helped financially support the legislation with no regulation attached.
Perhaps your organization's successful effort in Colorado will be lucky enough to back in to the need of licensure and regulation, after the evidence of unqualified O&P services, subsidized by carriers, are presented.You should closely monitor the trend and detrmine the source where consumers can present their complaints.
I would like very much to work with you on such future insurance reform endeavors in the 5 states that are currently regulated and perhaps bring such reform legislation attached to a California O&P regulation initiative.
Perhaps we could, after the determination of the proposed Patients Rights Bill, initiate interest from a Colorado and Florida U.S.Senators to sponsor a national Prosthetic Insurance Reform Bill to Congress along with the establishment of minimum educational standards of O&P providers that seek reimbursement for such services from Medicare.
Approximately 80% of national O&P services are billed thru Medicare!
Hope you are ready to get that leg back on and that the revision surgery was a success.
Ill let you know if I receive a response.
Tony Barr
From: Jeff Cain < <Email Address Redacted> >
> Jeffrey J. Cain MD
> Colorado Coalition of Working Amputees
> 303-722-4311
>
>
His group,CCWA, was successful in passing state legislation to mandate insurance companies in the state to provide prosthetic coverage to all working individuals in the state even though the Colorado presently has no state O&P regulation.
Below are my comments to him. Jeff is enthusiastic and wants to actively expand his insurance reform bill to other states and perhaps at a national level.
Perhaps a consumer/profession effort in the licensed states could begin a grass roots effort initiative with their model legislation.
Perhaps the NEW Academy leadership may have an interest in participating actively supporting on a state level (prioritizing states with O&P regulation) and at the national level? It seems apparent to me that support and enthusiasm to regulation efforts may be accelerated if O&P insurance coverage was mandated for our perspective states and those not yet regulated.
Feel free to contact Jeff who is very responsive to help in expanding prosthetic insurance reform to other states.
Let me know your thoughts.
Tony Barr
----- Original Message -----
From: Tony Barr
To: <Email Address Redacted>
Sent: Sunday, June 24, 2001 10:00 AM
Subject: Re: Prosthetic Insurance Reform
Hello Jeff, It was also nice to meet with you and share mutual inspirations and goals.
Agitate is certainly the proper word for gaining support for expansion of such reform!
The accomplishment that you and your group have generated in Colorado is commendable.
However, I fear that it will be short lived without mandating minimum provider education qualifications i.e.. regulation of the profession.I it is just a matter of time before providers whom are not qualified to provide O&P services will bill an insurance company for shoddy work.You cannot, for long ,mandate insurance coverages when unqualified providers are performing the services.
What other legitimate health care profession does not require a license to provide that service?
The only consumer complaint mechanism, in most unregulated states, is the Consumers Affairs Dept. which is buried under the State's Department of Agriculture.
The opposition to O&P regulation have cited the lack of documentation of consumers complaints to reason there is no need of establishing provider criteria and regulating the industry.
Perhaps the State of Colorado's Insurance Commission will oversee the new legislation?
Now that insurance providers in Colorado are required to provide O&P coverage, the large chains,Hanger O&P (632 facilities in the US) will, most likely, be able to provide the lowest bids for such services perhaps driving the qualified independent provider out of business. This is probably why they (Hanger) helped financially support the legislation with no regulation attached.
Perhaps your organization's successful effort in Colorado will be lucky enough to back in to the need of licensure and regulation, after the evidence of unqualified O&P services, subsidized by carriers, are presented.You should closely monitor the trend and detrmine the source where consumers can present their complaints.
I would like very much to work with you on such future insurance reform endeavors in the 5 states that are currently regulated and perhaps bring such reform legislation attached to a California O&P regulation initiative.
Perhaps we could, after the determination of the proposed Patients Rights Bill, initiate interest from a Colorado and Florida U.S.Senators to sponsor a national Prosthetic Insurance Reform Bill to Congress along with the establishment of minimum educational standards of O&P providers that seek reimbursement for such services from Medicare.
Approximately 80% of national O&P services are billed thru Medicare!
Hope you are ready to get that leg back on and that the revision surgery was a success.
Ill let you know if I receive a response.
Tony Barr
From: Jeff Cain < <Email Address Redacted> >
> Jeffrey J. Cain MD
> Colorado Coalition of Working Amputees
> 303-722-4311
>
>
Citation
Tony Barr, “Colorado Mandatory Prosthetic Coverage,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/217257.
