Health Insurance Coverage of Obesity Treatments Lacking

New data suggest that significant changes to reimbursement for the treatment of obesity are needed, researchers contend.  

Although obesity rates in the United States have skyrocketed in the past 3 decades, consumers often report that their health insurance will not cover obesity treatment, even in cases when employers target BMI in wellness programs, according to a study presented at ObesityWeek 2015.

Lack of Coverage

In the study, researchers analyzed data from a national survey given to 9388 anonymous respondents in February 2015. All the participants were aged at least 18 years.

They answered questions about medical services covered by their health insurers. Descriptive statistics were calculated and analyzed to identify significant patterns.  

According to the data, 3 of 4 consumers reported that their insurance does not offer coverage of evidence-based obesity treatment services.

“Even though insurance coverage of obesity treatment might be improving, we have a long way to go before it’s adequate,” said study investigator Theodore Kyle, RPh, MBA, who is the founder of ConscienHealth, a health policy consultancy in Pittsburgh.

“To the best of my knowledge, this is the largest published study of this question.”

Specifically, the study results showed that access to a registered dietitian was covered for only 28% of the respondents; medical weight management was covered for only 23%; bariatric surgery was covered for only 26%; and FDA-approved obesity drugs were covered for only 24%.

Results also indicated that 16% of employees reported their companies have wellness programs focused on BMI and that their companies offer incentives and/or penalties based on body weight or BMI. Coverage was somewhat better under these plans — 60% for a registered dietitian, 53% for medical weight management, 32% for bariatric surgery, and 30% for obesity drugs) — but many plans still excluded coverage, the researchers noted.

Cost Considerations

Kyle said these findings suggest that nearly 60 million U.S. adults with obesity do not have access to evidence-based treatments for obesity. He noted that there is a clear gap in treatment and stated that far too many Americans are being left with nowhere to turn for evidence-based obesity care.

However, making some simple changes could help lower morbidity and greatly lower overall healthcare costs, Kyle said.

“These findings are a wake-up call because without coverage for evidence-based obesity treatment, people are delaying medical care until they have complications that are quite resistant and costly to treat, [such as] advanced type 2 diabetes, fatty liver disease, cardiovascular disease, and degenerative joint disease, to name a few. So, it’s not a question of whether health plans will pay for the medical costs of obesity. Right now, we are paying for treating it in a very advanced form, with all of its complications,” Kyle told Endocrinology Advisor.

Studies have documented that obese individuals require significantly more office/clinic visits than normal-weight individuals, and therefore these findings may be of particular interest to endocrinologists, he noted.

“Their patients may delay seeking care for obesity and consequently present with more difficult clinical problems, if they don’t have coverage. More importantly, to treat type 2 diabetes, endocrinologists must spend a lot of time treating obesity and, quite naturally, they deserve to get paid for it,” said Kyle.

The Obesity Society Recommendations

In a position statement, The Obesity Society (TOS) recommended that all wellness programs include coverage for “responsible weight loss programs that use evidence-based interventions” and “a supportive workplace environment that provides opportunities for employees to be healthy and practice long-term healthy behaviors.”    

TOS has long advocated for insurance coverage of obesity treatments among all health plans, according to Emily Dhurandhar, PhD, chair of TOS’s Advocacy Committee.

Dr Dhurandhar, who is an assistant professor at Texas Tech University in Lubbock, said it is hoped that this new research will shed more light on the lack of access to evidence-based obesity care by health plans, including those offered by employers with wellness incentive programs.

She urges endocrinologists to speak out on this issue.

“As important stakeholders in treating obesity, the voice of endocrinologists would be a powerful addition to the conversation about improving coverage of obesity treatments in essential benefits packages. They can find the coverage details for their state’s essential health benefits (EHB) package on the Centers for Medicaid and Medicare Services website, and I would encourage them to talk to their state legislators and insurance commissioners if the full spectrum of care, including intensive behavioral therapy, weight loss drugs, and bariatric surgery are not covered in their state to express their concern over this discriminatory practice,” Dr Dhurandhar told Endocrinology Advisor.

Kyle said under the Affordable Care Act, proven obesity treatments and bariatric surgery are often not defined as an EHB. Subsequently, coverage by state plans varies greatly.

Reference

1. Kyle T, Nadglowski J. Abstract T-OR-2053. Consumers Report That Health Insurance Does Not Often Cover Obesity Treatment, Even When Wellness Programs Target BMI. Presented at ObesityWeek; November 2-6, 2015; Los Angeles, CA.
2. Three in Four Patients Are Not Covered for Obesity Treatments [news release]. Los Angeles, CA: The Obesity Society; November 4, 2015. http://www.obesity.org/news/press-releases/three-in-four-patients-are-not-covered-for-obesity-treatments. Accessed November 4, 2015.