Parity Question

Parity Question

Jim DeWees

6/25/2007

We are currently working on a prosthetic parity bill for Indiana, we have
had a few meetings so far getting organized and are in pretty good shape in
that regard. But, as always, we need more support from other providers and
professionals in this field, and also more support from as many amputees or
any other interested parties to help make this process a success.

I have been asked to gather as much information as possible from people in
other states on their efforts, victories, defeats, positive experiences,
negative experiences, what seemed to go smoothly, what were the hang-ups,
etc. Also, for those that have passed the bills, have you seen any
improvements on coverage (from an amputee view point and also from a
provider's view point). Have the states been able to enforce these bills?

Also, have any states gotten involved with the Department of Insurance (in
Indiana, it is called IDOI, Indiana Dept of Insurance), and worked with
them? Was that helpful at all?

Have any states come across issues based on ERISA, which protects HMO's and
self-funded insurance groups from being subjected to any of these parity
bills? In a conversation with the IDOI Health Deputy, she informed me about
ERISA and what it does to protect HMOs and that there is very little chance
of ever passing a state law that would supercede any federal mandates or
protections. I have researched some on this, and from what I have read so
far, she is correct. Basically, it states that an employer is can provide
insurance for their employees, and a self-funded group can have its own
network of providers, they can set their own fee schedules and the
limitations, coverage, etc. With that in mind, what influence can any
parity legislation have in the real world? I know it can affect some
insurance situations, but it will not touch any self funded or administered
HMOs. What experience do any of you have with this? Has it come up, or is
anyone aware of this issue?

I really need as much information from everyone that has any experience with
this, especially from Oregon, Rhode Island, New Jersey, Maine, Colorado, for
starters at least.

All information that I receive will be kept private. I am not going to
repost anything to the list, or anything of that nature. I am compiling
information and getting some ideas together so that we can plan our strategy
and make this as easy as possible. I don't want to have to re-invent the
wheel in this process, and so I am begging you to please help me and give
me some direction on how things worked out in your states.

Thanks,

Jim DeWees, CP

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