Source: First Coast News.com
Some insurance companies have helped obese patients fight fat for years. They’ve offered weight-loss and wellness programs at businesses, schools and in communities. Some have paid for prescription obesity medications and even covered expensive bariatric surgeries, including gastric bypass. But now most insurance plans are required to help obese patients try to lose weight under President Obama’s health care law. Exactly how they do it is up to the individual plans.
Screening and counseling for obesity has to be covered with no patient cost-sharing (co-payments, co-insurance or deductibles) by most insurers under the preventive services benefit of the Affordable Care Act, says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, the national trade association representing the health insurance industry. Medicare is already covering this service…
Insurance coverage for the treatment of obesity was back in the headlines recently when the American Medical Association, the nation’s largest physician organization, decided to recognize obesity as a disease that requires a range of medical interventions for treatment and prevention. Previously it referred to obesity as “a major public health problem.”
About a third of adults in this country are obese, which is roughly 35 or more pounds over a healthy weight. That’s a BMI of 30 and above. Obesity increases the risk of many other diseases, including type 2 diabetes, heart disease and some types of cancer. Those extra pounds rack up billions of dollars in weight-related medical bills. It costs about $1,400 more a year to treat an obese patient compared with a person at a healthy weight, research shows.
Obesity insurance coverage decisions for clinical preventive services under the Affordable Care Act are based on recommendations from the U.S. Preventive Services Task Force. It recommended screening for obesity and offering intensive counseling help at the doctor’s office or referring patients out for weight-loss help, says pediatrician David Grossman, a task force member. “We found 12 counseling sessions was the minimal amount needed for significant weight loss, but we didn’t see any benefits to going for over 26 sessions,” he says. The task force does not address what insurance companies should specifically cover…
Currently, Medicare pays for screenings and preventive services for obesity. Those appointments have to be with a primary care physician, nurse practitioner or a physician’s assistant. For counseling to be reimbursed, patients have to show progress with weight loss, she says. Unfortunately CMS does not reimburse if the weight loss counseling is with a registered dietitian or trained health coach, Ryan says.
Although she applauds Medicare’s efforts, she says several major research studies show that patients lose a significant amount of weight when they work in a comprehensive lifestyle program of skill-building in dietary and exercise habits under the guidance of a registered dietitian, a trained health coach, exercise specialist or psychologist. “We can get a 5% or more weight loss in about half the people who enter a behavior intervention comprehensive lifestyle program led by a nutrition professional. If we add weight-loss medications, we can produce a 5% weight loss in two-thirds of the people.”
…(But) Ryan is concerned that some health plans may just cover telephone counseling and not more effective programs such as comprehensive lifestyle interventions, prescription weight-loss medications and bariatric surgery, such as gastric bypass and gastric banding.
“It’s like all of medicine – you should give your most intensive therapies to your sickest patients,” she says. “In order to understand treatment choices in obesity, you need to factor in health risk. For low-risk patients, telephone counseling is fine. But for high-risk patients, you want a more intensive course of action. It’s not one-size-fits all.”