Relating to health benefit plan coverage for certain prosthetic devices, orthotic devices, and related services.
Impact
The legislation would significantly influence the landscape of health insurance in Texas by ensuring that individuals who require prosthetic or orthotic devices have clearer access to necessary medical coverage. This entails that any health benefit plan, including those offered in managed care settings, would have to comply with the new requirements, potentially reducing financial burdens on patients who might otherwise face challenges accessing these essential medical devices.
Summary
House Bill 806 focuses on expanding health benefit plan coverage for specific prosthetic and orthotic devices along with related services. The bill mandates that health benefit plans must provide coverage that is comparable to federal laws applicable to health insurance for the aged and disabled. Specifically, it ensures that coverage encompasses not only the devices themselves but also professional services related to their fitting and use, emphasizing the importance of medical necessity as determined by healthcare providers.
Contention
Despite the bill's intent to enhance accessibility for individuals in need of prosthetic and orthotic devices, there may be concerns from insurance companies regarding the implications for costs and administrative burden. Questions might arise about the enforcement and interpretation of what constitutes 'medical necessity' as defined by the treating physician. Furthermore, whether additional stipulations like prior authorization requirements will complicate access for patients exacerbates the ongoing debate about managing care and costs in healthcare.
To Modify The Arkansas Health Care Consumer Act; And To Require Coverage For Prosthetic Devices For Athletics Or Recreation And Prosthetic Devices For Showering Or Bathing.