Punitive Wellness Programs Are Already Here

The recent news of CVS demanding employees turn over weight, body fat, and other health data or pay a penalty stirred up quite a controversy. Regulations for wellness programs under Obamacare are on their way to becoming final. Health advocates are concerned that these new regulations might open the door to schemes that unfairly punish people with chronic diseases. But the fact is, punitive wellness programs are already here.

We got an unusually strong response to the CVS story. People responded who have lived for years with wellness programs that threaten them with stiff financial penalties. The story of one person who works for one of America’s largest healthcare corporations was especially complete and compelling. This person had a BMI of 67, which indicates very severe obesity, and lost more than 200 pounds before the employer wellness program even started. Despite this amazing accomplishment, the employer continued to threaten penalties to this person until their BMI reached a “normal” level of 25. Obesity medicine experts will tell you that such an expectation is unreasonable and perhaps unhealthy for a person who starts at a BMI of 67.

Here is this person’s story:

Why is CVS getting such backfire from everyone regarding the company requiring their weight through a wellness exam? My employer has been doing practically the same thing for at least 3 years.

If you don’t get your annual wellness check, then you then are pushed into the low level health plan that covers very little. It’s very cheap for monthly premiums and that’s great if you are never faced with having to see the doctor or going into the hospital. But if something unforeseen happens, most would have to take out a loan in order to pay the out-of-pocket expense of $4,000 plus a deductible of $1,000!!!!

Probably younger employees opt for the low level coverage, regardless of getting the wellness check, because most younger employees think they are bulletproof. And maybe they aren’t bringing home a paycheck to families as some of the senior employees are. The company offers better plans with better coverage and less out-of-pockets,  deductibles, and co-pays for visits to the doctor, ER, or hospital. Of course, there’s a bigger charge coming out of your paycheck.

The wellness exam includes getting weighed, blood work, and a blood pressure check. If you agree to take the exam, you are credited $400 to a healthcare spending account. They’ve cut that back from a $500 credit when they started the program. If you “pass” the exam with the “right” weight, blood pressure, and results for diabetes and cholesterol tests,  then the check goes no further. If you “fail” (something is out of the range they set), then you have to talk to a health counselor or go see your PCP to get a “clearance” letter.

All of this has to meet a deadline. If not, they drop your better health coverage to the lowest level, even though you originally chose the higher levels and you’re paying the higher premiums out of your paycheck. For those of us who already see the doctor regularly, it’s costly. It costs us extra time out off of work and money to our physicians.

I had gastric bypass before this program started. For the first two years of this wellness test, I didn’t meet the qualifications and ended up having to get “clearance” from my PCP just because of my BMI, even though I had reduced my weight from almost 400 pounds to 185. I’ve struggled losing those last few 25-30 pounds, but I proudly say that this past year, I passed the exam with flying colors in the first round without having to speak to the health counselor or see my doctor! I’m finally “normal” in the insurance’s BMI world!!!

If you don’t have a complex about still feeling “fat” for being “abnormal” for so long, these kinds of processes will SURE give you one! I think it’s great that companies are trying to create and promote wellness, but I feel sure there are better ways to go about it than “threatening” employees in these ways!

When we asked about what the employer did to help with obesity treatment, this is what we learned:

Regarding my surgery, even though I had a BMI of 67 along with co-morbidities, I still had to challenge the the health plan for them to cover it. Thank goodness I had a great network connection on the review panel who helped me through the process. Many patients don’t get access to that. That’s what led me to start working at a bariatric center six months post-op. I was out $250 for inpatient co-pay and around $2,500 for out-of-pocket costs. The center that did the surgery provides lifetime aftercare for surgeon, dietitian, exercise plan, and support groups. I am responsible for any lab charges (depending upon the health plan) and for follow up and bone density tests when needed. I’m also responsible for any complications, of course.

As far as my employer  covering any of these costs for aftercare, HA! The physician offices have to label the labs with a specific code not related to surgery to get them paid for by the health plan. Thank God they did in my case, because I have been severely anemic for the past 2 years. I’ve had to have IV iron infusions and weekly B12 injections for five years.

My employer will pay for one surgery per lifetime. If I have any complications or someone needs a revision from a band to a bypass due to situations beyond their control, too bad. We had one patient who needed follow up surgery for a complication that we took to the review board. They finally paid for it because of damage from her band. But it was a fight!!

And the health plan will not cover obesity treatment drugs. If your doctor prescribes it, you can pay for this out of pocket or through a flexible spending account if you have one.

This is how a company that says it’s devoted to health treats their employees with chronic diseases now. When we open the door to bigger financial incentives, what do you think will happen to employees in companies that are not devoted to health?

Click here to read more about the CVS wellness program and here to read more about concerns heath advocates have about such programs.

Punishment of Belly Smashing image © Dr. Meierhofer / Wikimedia

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