Does my health insurance cover weight loss treatments?
Crawford Frazer
The federal Centers for Disease Control and Prevention (CDC) found in 2008 that about one-third of adults and 18 percent of adolescents in the United States are obese, with a body mass index of at least 30.
Being obese or overweight can lead to a host of medical conditions that are expensive for patients and health insurance companies. But will your insurance company help you lose the weight before it gets to that point?
There are three main treatment methods for obesity, according to the National Heart Lung and Blood Institute: weight loss (bariatric) surgery, medications and nutritional/behavioral counseling. Whether your health insurance covers these things like it covers other medical treatments depends on your insurance company and even where you live.
Will my state make my health insurance company cover me?
In a 2010 state-by-state analysis, George Washington University researchers found that only some state Medicaid programs cover all recommended obesity treatments, that many states allow insurance companies to charge obese patients more in premiums, and that a handful of states allow insurance companies to limit coverage of conditions linked to obesity.
Yet increased coverage for obesity treatments seems to be a growing trend, according to the American Society for Metabolic and Bariatric Surgery. In 2009, for example, the federal Centers for Medicare & Medicaid Services established regulations that would provide bariatric surgery coverage for Medicare and Medicaid recipients if their obesity put them at risk for Type 2 diabetes, disability or death.
On the state level, Alabama and North Carolina have approved obesity-related incentives to undergo health screenings. Georgia, Mississippi and Virginia have limited regulations that provide coverage for bariatric surgeries. And Indiana, Michigan and New Hampshire require coverage for bariatric surgery if it’s deemed medically necessary, according to the American Society for Metabolic and Bariatric Surgery.
Will my health insurance plan cover me?
Some health insurance companies will cover weight loss treatments, but what they are willing to cover often is limited. Most of Aetna’s plans, for example, exclude weight loss surgery unless Aetna approves it, according to a policy bulletin on the company’s website.
And what would lead Aetna to approve (and cover) a surgery? A patient must meet a variety of criteria, including a certain body mass index or obesity-related conditions like sleep apnea, coronary heart disease and Type 2 diabetes. Patients also must participate in a multidisciplinary surgical preparatory regimen, which serves as proof of an attempt to lose weight and failure to do so, before qualifying for surgery, according to Aetna.
Health savings accounts (HSAs) and flexible spending accounts (FSAs) provide another option. These accounts let you set aside tax-sheltered money for medical expenses — which can include expenses related to weight loss.
According to CIGNA, its HSAs and FSAs can be used for weight loss programs if prescribed by a physician to treat a specific medical condition, like heart disease. A physician’s diagnosis letter also can unlock HSA and FSA funds for things like fitness equipment, pedometers, scales, recipe books and gym memberships.
