Obesity is a major health issue in the US. Twenty-two states including Texas reported 30-35% obesity rate for adults in 2017. That means roughly one third of Texas is at a high risk of obesity related diseases such as diabetes, high blood pressure or cholesterol, and kidney disease. While most medical insurance plans cover the diagnosis and treatment of these conditions, historically very few policies include surgical treatment options for the underlying cause. More insurance policies are starting to include some form of obesity treatment after the Affordable Care Act was passed. The coverage varies widely, but here are a few options that are gaining more traction.
A bariatric surgery to physically limit the amount of food a person can consume and digest is the most drastic step a person can take toward weight-loss. Unfortunately, a typical bariatric procedure for weight loss costs $20,000-$25,000 depending on the type of surgery and a few other factors. Many employer sponsored medical plans are beginning to provide benefits to help cover these costs but patients must meet a strict set of guidelines to qualify for coverage. These can include a diagnosis of two or more obesity related diseases, pre-surgical counselling, and/or failure of other treatment options. In some cases, the patient must also pay out their yearly out-of-pocket maximum or a very large co-pay before insurance will pay anything.
Weight Loss or Nutritional Counseling
Weight loss and nutritional counseling is one of the slowest methods of weight loss, but is more commonly covered under medical insurance when prescribed by a qualified medical professional. These counseling sessions are designed to help you develop healthy eating habits, control cravings, and identify the areas you struggle most. Many times your doctor will give you guidelines for a workout plan. Several major medical carriers offer discounted gym memberships to their policyholders, so contact your insurance company or benefits administrator to see if one available to you.
Weight Loss Medication
There are a handful of prescription drugs currently on the market designed to assist in weight loss with many more currently in FDA trials. Most of these medications work in different ways so there are options to figure out which one is for you. Some are designed to make you eat less, while others prevent your body from absorbing excess fat calories. Some insurance policies will cover certain medications under the medical policy instead of the prescription benefit if you meet the criteria. Several of the medications on the market are available in a generic form, making them much more affordable even without insurance.
It is important to remember that all medical weight loss options are to be supervised by your physician and require changes to your diet and exercise habits. If you are seeking help with weight loss from your doctor, you will need to discuss your options with your medical insurance carrier first.
If your company is looking for benefit education, financial literacy, or help navigating ACA regulations, contact a benefits consultant today.