Advocates press Senate committee to require insurance cover activity‑specific prosthetics and orthotics

Senate Bill 699 would require health insurance plans covered by Oregon insurance code to cover prosthetic and orthotic devices when determined medically necessary for people with limb loss, and explicitly extend coverage to activity‑specific devices used for physical activity such as running, biking and swimming.

Senator Lisa Reynolds, a physician and sponsor of the bill, told the committee SB 699 builds on prior legislation (Senate Bill 797, 2023) and is intended to ensure insurance coverage supports “whole body health” rather than only activities of daily living. She said providers and patients would still need to document medical necessity.

Advocates, clinicians and people with limb loss described personal harms from lack of coverage. Nicole Verkheilen of the Amputee Coalition recalled being denied a waterproof or activity-capable prosthesis in childhood and said lack of access caused long‑term pain and additional therapy. Prosthetists and orthotists, including Noelle Medina, said clinicians often must deny coverage for activity devices even when medically appropriate. Tristan Thomas, a disabled veteran who testified, contrasted comprehensive VA coverage with gaps in commercial and Medicaid coverage and said out‑of‑pocket costs for activity devices can exceed $10,000–$12,000.

Insurers PacificSource and Cambia (Regions Blue Cross Blue Shield of Oregon) spoke with concerns about cost, reach and implementation. PacificSource estimated the mandate would affect about 23% of Oregonians subject to the insurance code and quoted an actuarial estimate of about $3 per member per month (roughly $5 million a year across fully insured markets); Cambia urged retaining medical‑necessity review to ensure appropriate device selection and said current law and implementation timelines should be clarified to avoid unintended costs and poor outcomes.

Supporters pointed to interstate precedents and to Department of Veterans Affairs practice, and to a national fiscal study cited in testimony that estimated low per‑member costs with potential long‑term savings through improved employment and health. Committee members asked questions about scope, plan applicability (including Medicaid/OHP, PEBB, PERS/PEBB, and self‑insured plans) and timing. Witnesses and insurers acknowledged technical changes and an operative date change to Jan. 1, 2026 were forthcoming to aid implementation.

The committee closed the public hearing without a final vote; sponsors and advocates urged passage to expand opportunities for exercise, employment and long‑term health for people with limb loss or limb difference.