Fire Drill

Health Plan Enrollment: Time to Ask About Obesity Care

Health plan enrollment season has rolled around again. Maybe the brochures from your HR department are coming your way. Or perhaps you’ve noticed that our president is fiddling with the framework for health plans. Whatever grabbed your attention, it’s a good time to take a look at your options. What will you be getting for your money?

Options for Obesity Care Vary Widely

It’s a fact. Options for obesity care under different health plans vary widely. Some plans are stuck in the past. They either treat obesity as a cosmetic concern or pay only lip service to covering obesity care. Some even explicitly exclude medical care for obesity from their covered services – “regardless of medical need.”

Others have wised up, covering a full range of services from lifestyle support, to medical obesity care and surgery when necessary. Many plans fall somewhere in between.

TRICARE, the program that covers military families and retirees, is a good example of progress. Starting in January, new rules will specifically require coverage for obesity care.

Bottom line, it pays to ask. What is covered under different options? Which plans will cover care delivered by an obesity medicine physician? Will the plan cover consultations with a registered dietitian? Does the drug plan cover FDA-approved obesity medicines? What are the provisions if a plan member needs bariatric surgery?

Pay Attention to Out of Network Benefits

One detail that deserves your attention is coverage for out of network care. If a skilled specialist in obesity care isn’t a network provider, what kind of coverage will you receive? Some plans make it hard or provide very little coverage. Others will work with you. It pays to compare.

This is the time to ask good questions about coverage for the care you need. Your health plan and your HR benefits manager is a good place to start.

Health plans that neglect obesity care are sending the wrong message. Vote with your enrollment pen.

For more about out of network benefits, click here. You can find some helpful insight on picking a plan here, here, here, and here.

Fire Drill, photograph © Manchester Fire / flickr

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October 15, 2017