Game Pieces

Health Insurance Games: Adolescent Edition

It seems that even children who are seeking help with severe obesity cannot escape the games that health insurance companies play. A new study in Obesity documents the difficulty with health insurance that adolescents who have severe obesity experience, even when they have a well-documented need for bariatric surgery.

Thomas Inge and a team of pediatric obesity experts analyzed the data for a series of adolescents at five children’s hospitals. The teens met all the clinical criteria for requiring bariatric surgery. Most of them were initially denied coverage by their health insurance carriers. On appeal 80% of the denials were reversed. The excuse for rejecting the request was usually age less than 18 or a quibble with the procedure selected by the patient and doctor.

The result of this runaround is a delay in urgently needed care amounting to months and sometimes stretching out for more than a year. These cases were processed between 2009 and 2011. They typically involved adolescents with BMI greater than 50 and major medical complications related to obesity. This practice by insurers stands in sharp contrast to the experience documented for adults with health insurance who need bariatric surgery. Studies have shown that 80-85% of adults with coverage get approval without any need for appeal.

No doubt the leadership of these health plans are among the many people who solemnly talk about their concern about childhood obesity. Many have PR campaigns on the subject.

It’s time for health plans to walk the talk about childhood obesity.

Click here to read the study in Obesity.

Game Pieces, photograph © JanetandPhil / flickr

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