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Most health plans still resist covering weight-loss treatment

But consultants say that with a movement to treat obesity as a disease, more insurers may consider coverage.

By — Posted Aug. 19, 2013

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A July study naming the top 10 medical services that aren’t covered by most insurers showed that long-term care, cosmetic surgery and infertility treatments take the top three spots. But No. 4 on the list is weight-loss programs, with about 93% of health plans indicating they are not covered.

The study by HealthPocket, a technology company that compares and ranks health plans, also showed weight-loss surgery in eighth place after private nursing, acupuncture and children’s dental checkups.

But health care consultants say that with a greater spotlight on obesity, which is associated with disorders such as diabetes and hypertension, insurance plans may start covering weight loss more.

In June, the American Medical Association’s House of Delegates declared obesity a disease. Shortly thereafter, lawmakers in Washington began considering legislation to make weight-loss services cheaper for Medicare patients. The Treat and Reduce Obesity Act, the bipartisan legislation under consideration in the U.S. House, would require Medicare to cover prescription drugs for chronic weight management. It also would make it easier for these patients to receive weight-loss counseling.

Also, the Affordable Care Act designates obesity screening and counseling as part of preventive services that are covered with no out-of-pocket expense to insured patients.

Challenge of long-term treatment

The survey is the first time HealthPocket has looked at what health plans typically don’t cover, said Kev Coleman, head of research and data at HealthPocket. It appears that many of the excluded services are high-cost procedures that take place over long periods of time, he said.

“I think it has to do with big upfront costs that don’t necessarily result in lower costs three to six years down the road,” Coleman said. “If you take someone who is morbidly obese and they have to lose 100 pounds, to do it in a medically responsible fashion, it’s a slow process.”

As research into obesity prevention ramps up, it’s likely more health plans will cover more weight-loss services — or at least that’s the hope, said James Zervios, a spokesman at the Tampa, Fla.-based Obesity Action Coalition. That research already has produced new prescription drugs that may provide lower cost alternatives to surgery or other weight-loss measures, he said.

But attention to issues doesn’t mean that health plans will follow suit. What drives coverage is evidence that medical services work, said Susan Pisano, vice president of communications for America’s Health Insurance Plans, the trade group representing insurers. As more evidence is available about the safety and effectiveness of services or procedures, the more likely they will be covered, Pisano said.

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