NEW JERSEY – The Assembly on Thursday released a bill that would require health benefits plans to cover additional prosthetic devices.
The bill (S1439/A3856), sponsored by Assemblyman Antwan McClellan, specifies that devices prescribed by a patient’s physician and provided by licensed orthotists, prosthetists or pedorthists for physical or recreational activities must be covered. Current law does not mandate that coverage.
“Additional prosthetic devices for physical activity promote mental and physical well-being and enhance quality of life,” McClellan (R-Cape May) said. “Studies show physical activity reduces risks of depression and chronic diseases, which are issues that can disproportionately affect amputees without access to such tools.”
Basic prosthetics for upper or lower body can cost up to $10,000, while more advanced options—above-the-knee prosthetics with features such as microprocessor-controlled knees or multi-axial movement, or myoelectric arms that respond to muscle signals—can cost upwards of $100,000. Those prices exclude fittings and any maintenance. Devices must be replaced every five years or less, due to wear and tear.
Additional devices, which are covered under McClellan’s bill, would include a running blade, which can cost between $10,000 and $30,000.
Healthcare providers would be reimbursed at the same rate as the Medicare reimbursement schedule.
“It’s not about running marathons, although if that’s their goal, I say go for it!” McClellan added. “It’s about giving amputees the opportunity to live a full life without financial ruin.”
The bill now goes to the governor’s desk for signing.
