Monday, August 23, 2010

Reimbursement Continues to Be an Issue in Weight Loss and Weight Management

Insurance companies are more likely to reimburse weight loss surgery providers than non-surgery weight loss providers. And there is a reason for this difference in reimbursement practices: There is less of a proven payback for non-surgical weight loss protocols than for surgical weight loss protocols.

Indeed, researchers in France reported that "Bariatric surgery was associated with significant reductions in reported claims for short- and long-term health outcomes and reduced medication use for major disease categories." So reimbursing a bariatric surgical provider seems cost effective.

However, there may be hope for non-surgical weight loss and weight management treatment reimbursement. A 2007 study done at the University of Kentucky, Departments of Pediatrics suggested that there were improvements in the reimbursement rates associated with non-surgical weight loss treatment -- at least for children.

In fact, the researchers carrying out the study stated that while "preventive counseling [for weight management] has not been routinely reimbursed very well by third-party payors," there was "improved reimbursement rates for the evaluation and management of overweight children."

But still, it is apparent that the reimbursement level for non-surgical weight loss and weight management is not what it should be -- even for children. A docu-drama , entitled “Too Fat for Fifteen: Fight Back" aired on the Style network, suggests that insurance reimbursement for non surgical weight loss treatment is lacking, when it comes to treatment for childhood obesity.

One of the parents of a teen highlighted in the docu-drama stressed that “We want the insurance industry to provide some reimbursement for families.” The parent went on to say that “It’s better to make an investment in the child now than wait until their 20s and 30s when they have issues like cardiovascular disease and they need medications.”

But one of the reasons insurance companies are reluctant to reimburse non-surgical weight loss or weight management treatments is the dearth of proven non-surgical weight management protocols. However, ongoing exercise and dietary counseling, and other interventions, can lead to weight loss and weight management success. One of the students depicted in the docu-drama, so far, has lost over 51 pounds. This type of success will lead to improved reimbursement.

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