For 12-Year-Old Without an Arm, Insurance Has Run Out (already met his lifetime maximum benefit)

Source: Huffington Post

For 12-Year-Old Without an Arm, Insurance Has Run Out
State Rules Vary Widely on Prosthetics and Other Health Needs

Twelve-year-old Benjamin French is ineligible for prosthetics coverage because he has already met lifetime maximum benefit.
By Danielle Ivory
Huffington Post Investigative Fund
5:31 pm | 16 Nov 2009

Benjamin French was born with his right arm missing below the elbow. In his 12 years, he has been fitted with seven prostheses. His most recent replacement will cost nearly $30,000 and his doctor says he will soon grow out of it.

But, according to his insurance company, the boy is ineligible for further coverage of prosthetic devices because he has already met his lifetime maximum benefit.

Benjamin’s family happens to live in Michigan, one of 33 states where insurance companies are allowed to set annual and lifetime caps on prosthetic coverage. The family’s policy with Blue Cross Blue Shield of Michigan covers a maximum of $30,000 per lifetime for prosthetics, plus $1,000 per year for repairs. In states such as Colorado and Maryland, the law says there can be no such cap on prosthetics.

“It seems really unfair,” said Benjamin’s mother, Kristen French. “The insurance company can do this in one state, but not in another? It’s ridiculous.”

Read more: http://huffpostfund.org/stories/2009/11/12-year-old-without-arm-insurance-has-run-out#ixzz0X8AgOCJi



Read more: http://huffpostfund.org/stories/2009/11/12-year-old-without-arm-insurance-has-run-out

yay Blue Cross.

:sarcasm:

They are a shit-tastic company and poster child for everything that's wrong with health insurance in this country.

after 3 month when she when back to work, she was laid off so she has lost her health insurance, now she is without insurance if she ever needs medical care she may have to sell her house to pay for it.

one employee with an expensive condition will cause employer premiums to go sky high, giving employers an incentive to get rid of the employee.

Isn't the American healthcare system wonderful?

they were looking for ways to let her go, at first they try by giving her more overtime, then changing her daily shift

This chart is from 10/08 Services Provided by State

http://medicaidbenefits.kff.org/service.jsp?yr=3&cat=11&nt=on&sv=34&so=0&tg=0

Here's some examples

Alabama
Limited to basic level prosthetic and orthotic devices determined medically necessary; prosthetic eyes or lenses, devices to close oral cavity created by congenital defect or surgery, internal life-supporting devices are also covered

Arkansas
Orthotic appliances limited to $3,000/year, prosthetic devices limited to $20,000/year

Mississippi doesn't cover orthotics or prosthetics

Penn (requires a copay)
Limited to orthopedic shoe inserts and selected orthotics, specified frequency and quantity limits apply

and lots more

to cross state lines to get health insurance. All the companies will be lined up to move to Mississippi so they can offer "affordable coverage".

Didn't know their was such a thing.

Yes, they exist, and it's stupid, and another reason for single payer HEALTH CARE, not health insurance. NOTE: insurance here is a noun and means an insurance product of an insurance company, not the adjective meaning to insure, ensure, or assure that health will be a result of said insurance product. Oh, bummer, that's supposed to be in small print, not bold. Darn.

I agree insurance coverage shouldn't run out for the kids prosthetic needs.

I just think the arm is a great example of the gross overcharging of the medical industry.

they are even more costly for non amputees than for amputees who are somewhat standardized. missing limbs from birth are another matter and many prosthetists don't have much experience with them, they take more time and there are numerous adjustments. not only that, the technology in these devices to restore function is getting better but it is costly.