http://huffpostfund.org/stories/2009/11/12...

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

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 spent 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.”

The French family represents one small part of a health care system rife with inequities and inconsistencies: Some people have insurance, some do not. Clarification Nov. 17, 2009: Original language implied Blue Cross Blue Shield of Michigan is a for-profit insurer; it is nonprofit. For those who are insured, individual policies operate under different rules than group policies. Each insurance company and every individual policy has different requirements, exclusions, and benefits.

And, as in the case of Benjamin French -- people with nearly identical health problems may have vastly different experiences with their private health insurance companies depending on their state of residence. Another example of the inequity: If Benjamin’s family were poor enough to qualify for Medicaid, most if not all of the cost of his new arm would be covered.

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