Parity
Elizabeth Mansfield
Description
Collection
Title:
Parity
Creator:
Elizabeth Mansfield
Date:
9/1/2006
Text:
Dino,
As a non-O&P wearer who was born into the O&P field and has worked on behalf of parity for the last few years I'd like to offer an opinion - just about parity, though!
Any time that I have been involved in parity efforts, the legislation has NEVER ever required all insurance companies to provide O&P care. (I am quite sure that you couldn't even write legislation that could require it.)
To my knowledge, parity efforts have only tried to ensure that insurers that offer O&P coverage as part of their benefit plan, do so without imposing:
arbitrary monetary caps
i.e. 1500 per year
or lifetime limits
i.e. one prosthesis per lifetime or initial prosthesis only
or restricting the type of components used based solely on the cost
i.e. excluding myoelectric or microprocessors
Paddy Rossbach of the ACA has said The goal (of parity legislative efforts) is not legislation - it is coverage.
My personal opinion is that anything that we can do to raise awareness about the lack of adequate insurance coverage for O&P wearers, we should do.
We should NOT pass laws just to pass them - if adequate, appropriate coverage is the goal, then useless, uneforceable and ineffective laws are just as bad, if not worse, than inadequate coverage.
Legislative efforts, successful or unsuccessful, are a means to an end if you are trying to educate and persuade others that change is necessary.
I agree with Paddy that you do not necessarily need to pass laws in order for change to occur, however, it is often an effective means of raising awareness and can ultimately help you achieve your goal.
The goal being adequate, appropriate coverage for O&P.
Elizabeth
Dino M. Scanio < <Email Address Redacted> > wrote: I was wondering when someone was going to realize that Linkia is not such a stellar concept; unfortunately it was a patient who had the realization of how exclusionary Linkia is. Patients will suffer by limiting who can provide O & P care. Daniel Gottry clearly explained from a patient point of view how his prosthetic care was compromised by Linkia and Cigna. Let’s now think about Linkia as it relates to the issue of parity.
Before I begin, let me simplistically rationalize what parity is. Parity is the idea that all insurance companies MUST provide O & P care. So is this in the best interest of the O & P profession? NO, because it would force insurance companies into one of two options. Option one would be to open a new division within their company to handle the O & P coverage. This would be very expensive for insurance companies and would defeat the purpose of “cost effective money management.” The second choice, and smarter one for the company, would be to contract with a third party payer such as Linkia to handle their new business of O & P coverage. Is parity such a good idea for the patient when it will exclude the majority of providers and limit the quality of care? I can only hope that the private O & P business owner realizes that they will not have the opportunity to get a piece of that pie because Hanger and Linkia will be consuming the whole pie, without equally sharing the
t!
aste of profit.
To be the devil’s advocate, parity is very beneficial for those patients whose insurance plans allow no O & P coverage. This will give them an opportunity to receive O & P care. But if Linkia is involved, Hanger will be obtaining the business and no one else.
As an orthotist, I believe parity is not in the best interest of the O & P profession as a whole! I am hoping as practitioners, we can continue to educate ourselves on these issues so that before parity legislation passes, we can either support or fight against it. It now makes sense why Hanger is willing to support parity in each state.
Dino M. Scanio, C.O.
As a non-O&P wearer who was born into the O&P field and has worked on behalf of parity for the last few years I'd like to offer an opinion - just about parity, though!
Any time that I have been involved in parity efforts, the legislation has NEVER ever required all insurance companies to provide O&P care. (I am quite sure that you couldn't even write legislation that could require it.)
To my knowledge, parity efforts have only tried to ensure that insurers that offer O&P coverage as part of their benefit plan, do so without imposing:
arbitrary monetary caps
i.e. 1500 per year
or lifetime limits
i.e. one prosthesis per lifetime or initial prosthesis only
or restricting the type of components used based solely on the cost
i.e. excluding myoelectric or microprocessors
Paddy Rossbach of the ACA has said The goal (of parity legislative efforts) is not legislation - it is coverage.
My personal opinion is that anything that we can do to raise awareness about the lack of adequate insurance coverage for O&P wearers, we should do.
We should NOT pass laws just to pass them - if adequate, appropriate coverage is the goal, then useless, uneforceable and ineffective laws are just as bad, if not worse, than inadequate coverage.
Legislative efforts, successful or unsuccessful, are a means to an end if you are trying to educate and persuade others that change is necessary.
I agree with Paddy that you do not necessarily need to pass laws in order for change to occur, however, it is often an effective means of raising awareness and can ultimately help you achieve your goal.
The goal being adequate, appropriate coverage for O&P.
Elizabeth
Dino M. Scanio < <Email Address Redacted> > wrote: I was wondering when someone was going to realize that Linkia is not such a stellar concept; unfortunately it was a patient who had the realization of how exclusionary Linkia is. Patients will suffer by limiting who can provide O & P care. Daniel Gottry clearly explained from a patient point of view how his prosthetic care was compromised by Linkia and Cigna. Let’s now think about Linkia as it relates to the issue of parity.
Before I begin, let me simplistically rationalize what parity is. Parity is the idea that all insurance companies MUST provide O & P care. So is this in the best interest of the O & P profession? NO, because it would force insurance companies into one of two options. Option one would be to open a new division within their company to handle the O & P coverage. This would be very expensive for insurance companies and would defeat the purpose of “cost effective money management.” The second choice, and smarter one for the company, would be to contract with a third party payer such as Linkia to handle their new business of O & P coverage. Is parity such a good idea for the patient when it will exclude the majority of providers and limit the quality of care? I can only hope that the private O & P business owner realizes that they will not have the opportunity to get a piece of that pie because Hanger and Linkia will be consuming the whole pie, without equally sharing the
t!
aste of profit.
To be the devil’s advocate, parity is very beneficial for those patients whose insurance plans allow no O & P coverage. This will give them an opportunity to receive O & P care. But if Linkia is involved, Hanger will be obtaining the business and no one else.
As an orthotist, I believe parity is not in the best interest of the O & P profession as a whole! I am hoping as practitioners, we can continue to educate ourselves on these issues so that before parity legislation passes, we can either support or fight against it. It now makes sense why Hanger is willing to support parity in each state.
Dino M. Scanio, C.O.
Citation
Elizabeth Mansfield, “Parity,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/227312.
