Dear
Are you aware that our company’s health plan contains an exclusion for the medical treatment of obesity? I’m not referring to anti-obesity medications, but medical office visits, even when they are medically necessary. Many times, when choosing a health plan, this type of discriminatory benefit design is overlooked.
In addition to refusing to pay for medical treatment for obesity, this exclusion has the potential to allow carriers to exclude treatment for other diseases if obesity is being addressed at the same time. Deliberately excluding treatment of obesity can have devastating long-term consequences for members suffering from this disease, not only preventing them from directly addressing excess weight but also has the potential consequence of preventing them from accessing care for other conditions related to their weight, for fear these services will be denied.
Obesity is a complex, multifactorial, common, serious, relapsing, and costly chronic disease that serves as a major risk factor for developing conditions such as heart disease, stroke, type 2 diabetes, renal disease, non-alcoholic steatohepatitis, and certain types of cancer. Every major medical organization in the United States supports and recommends comprehensive evaluation and treatment of patients suffering from obesity.
Excluding the treatment of this disease from a health plan blatantly disregards the recommendations made by The American College of Cardiology (ACC), The American Heart Association (AHA), The Obesity Society (TOS), The American Association of Clinical Endocrinologists (AACE), The American College of Endocrinology (ACE), and the American Gastroenterological Association (AGA), among many others.
In addition, carving obesity treatment out of a health plan demonstrates significant bias. Non-Hispanic Black adults have the highest prevalence of obesity, followed by Hispanic adults. Denying treatment for obesity disproportionately affects these ethnic and/or racial groups, thereby widening the health disparities that already exist in the United States.
I am writing this to encourage you to reconsider this carve-out and consider covering medical office visits for members when excess weight is discussed and/or weight loss is recommended. I understand refusing to cover commercial weight-loss programs or services performed in a med spa – this isn’t what I’m referring to. Our area has several medical clinics staffed by physicians board-certified in Obesity Medicine and mid-level providers with advanced training in Obesity Medicine. These clinics treat the disease of obesity using evidence-based medicine and operate similarly to other medical clinics.
There is a plethora of data that a 5% decrease in weight results in clinically significant improvements in most obesity-related comorbid conditions. Timely management of obesity can be cost-effective, lower health risks, and prevent disease progression. Estimates have shown that the annual medical cost for people who have obesity are on average 42% -75% higher than those of normal weight, with costs increasing significantly with the severity of obesity.
Providing coverage for high-quality medical treatment for the disease of obesity can prevent catastrophic events and significant increases in the overall cost of healthcare. Rather than discouraging employees from seeking out these services, they should be encouraged.
If removing the carve-out isn’t an option until we renew our benefit plan, I am requesting that the services I receive from Heartland Weight Loss (one of these Obesity Medicine clinics in the area) be covered. Although it would be ideal if the visits were covered similarly to preventive health services, I understand that they may be subject to standard copays, deductibles, and out-of-pocket responsibilities.
If you want to learn more about Heartland Weight Loss before making a final decision, you can learn more at www.HeartlandWeightLoss.com or you can reach out to them directly at Succeed@HeartlandWeightLoss.com The office was founded by Courtney Younglove, M.D., who is board-certified in Obesity Medicine and is one of only seventy physicians in the US and Canada who has earned her fellowship from the Obesity Medicine Association. Dr. Younglove and her team feel strongly that patients struggling with obesity should have access to high-quality medical treatment – and should not have to rely on commercial programs or med spas to obtain care. Although the office was founded as an insurance-based business, as more and more health plans have started carving out Obesity Medicine services and patients have been forced to pay out of pocket, they have shifted to a more diverse payment structure/model. If you wanted to cover their services for other employees or plan participants, I’m sure they would be willing to work with you to simplify reimbursement.
Thank you for supporting me as I work on improving my health and my weight. Improving my health will not only benefit me individually but should also help the company as a whole. In addition to decreasing overall healthcare costs, reducing obesity typically results in happier, more productive employees.
Regards,