Managed care plans are accredited by the National Committee for Quality Assurance (NCQA). However, NCQA does not examine services for obesity of any health plan. Addressing obesity is essential to the integrity of a national system of accreditation of managed care providers.
Medicare is the federal program that provides health services for the elderly and the disabled. In July 2004, the Medicare policy changed to reflect the seriousness of obesity as a medical condition.
Previously, Medicare did not consider obesity to be a disease or illness and thus made no payments for any services in connection with it. The new Medicare policy, according to the Department of Health and Human Services (HHS), "would remove barriers to covering anti-obesity interventions if scientific and medical evidence demonstrate their effectiveness in improving Medicare beneficiaries' health outcomes."
The president of the American Obesity Association stated that the new Medicare policy is a "decision that will open the door not only for better insurance coverage but more medical research and increased education on obesity at the nation’s medical and other health schools."
The Medicaid program, a joint federal-state program for the coverage of the
poor and the disabled, does not recognize obesity as a disease. However, some states do pay for obesity surgery, although the frequency of such cases and low reimbursement rates would indicate that not much surgery
is being performed.
What Can I Do?
From the information we have provided, you can use what is helpful to explain the importance of coverage and reimbursement for obesity treatment to your employer, managed health care plan or insurance company. Help change the picture
on reimbursement. If not for you, do it for the millions of adults and children
who need help paying for treatments.
Be an advocate. Changes in employer paid health insurance or public programs
like Medicare and Medicaid will not come overnight. And the changes will not
happen until people like you start demanding it. AOA has tried on this site
to connect you with the information you may need to help make the case for change.
If your plan changes coverage or you have an interesting experience to report,
let us know so that we tell others.
For more information on health insurance coverage, read these AOA educational
materials:
For further assistance dealing with your health insurance provider, check out the web site of the:
For an example of what some health insurance providers cover in their policies regarding obesity, read:
If you believe that you have a legal claim regarding the denial of health insurance
coverage for obesity treatment:
Several states are looking at laws mandating insurance companies' coverage
of bariatric surgery. For information to take to your insurance company on bariatric
surgery, read the Rationale
for Surgical Treatment of Morbid Obesity.
