A weighty issue: Health insurers are helping policyholders lose weight to help trim claims costs. (Life/Health: Claims Costs).
The Centers for Disease Control and Prevention reports that about 61% of adult Americans are either overweight or obese, defined as having a body mass index of 25 or more, and 13% of children and adolescents are seriously overweight. Weight problems can lead to diabetes, high blood pressure, high cholesterol, heart disease and more.
Obese people spend 36% more in inpatient and outpatient care and 77% more in medications than smokers or problem drinkers, according to a study published in Health Affairs, a journal of health policy and managed care.
Obesity and its costs to insurers are a concern for the entire industry, said Dr. Janet Maurer, corporate medical director of Cigna. Obesity organizations say the condition should be considered a disease covered by insurance companies. About $118 billion a year is spent for the care of obesity-related diseases and indirect costs, such as loss of productivity, according to USA Today, which quoted an analysis by Anne Wolf of the University of Virginia.
Some say the Internal Revenue Service is paving the way for insurance coverage of obesity treatment. The agency now recognizes obesity as a disease and will allow taxpayers to claim weight-loss expenses as a medical deduction, according to recent press reports. To qualify for the deduction, the person would have to take part in a weight-loss program for medically valid reasons, rather than joining a gym or a weight-control program to improve appearance or general health, without a doctor's guidance.
A Doctor's Decision
But Susan Pisano, spokeswoman for the American Association of Health Plans, said whether obesity is considered a disease is for the medical community to decide, not health insurers.
"Insurers cover the things that will work," Pisano said. "With respect to many of the kinds of treatments that we're all hopeful would work for obesity, there's not a lot of information to suggest that we have a lot of good treatments."
The prescription weight-loss drug, fen-phen, which was often prescribed in the 1990s, resulted in heart problems and a lawsuit. Even so, health insurers are taking obesity seriously
According to a survey of health insurers, 50% of the 60 respondents said they offer financial incentives to weight loss, such as discounts on health club memberships and health education classes. The survey was conducted by the Blue Cross Blue Shield Association and Partnership for Prevention, a national nonprofit organization.
Many insurers cover bariatric or gastrointestinal surgery, which press reports said can cost $20,000 or more. Humana, Cigna, Aetna and Blue Cross Blue Shield, for instance, cover the surgery under certain circumstances.
In March 2001, Blue Cross & Blue Shield of North Carolina said it had classified as "investigational" and would no longer cover minigastric bypass surgery. The reason cited was that some providers were doing the procedure differently from the established covered procedure. WellPoint covers the minigastric bypass procedure, but only if it is medically necessary.
To encourage weight loss the old-fashioned way, the Massachusetts Blues pays up to $150 a year for each member to join a health club, as long as the member has been going to the gym for the previous four months, said Chris Murphy, a spokesman for the Blues. The company also offers a 20% discount to see a nutritionist in its network if a primary doctor refers the patient. And the insurer covers the registration fee for Weight Watchers and offers a 25% discount on a 12-week program.
Maurer said most of Cigna's customers have not requested coverage for weight-loss drugs in their plans. Other health insurers said they don't cover prescription weight-loss drugs.
RELATED ARTICLE: How Fit Are You?
Medical experts use body mass index to determine if a person is overweight, obese or in the normal (healthy) range. A healthy DM1 for adults is between 18.5 and 24.9. BMI ranges are based on the effect body weight has on disease and death. A 6-foot-tall male weighing between 140 pounds and 177 pounds is in the normal range. Several Web sites offer BMI tables and online calculators. Here are a few:
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|Comment:||A weighty issue: Health insurers are helping policyholders lose weight to help trim claims costs. (Life/Health: Claims Costs).(Brief Article)|
|Article Type:||Brief Article|
|Date:||May 1, 2002|
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