The Antique Inheritance Tortures the Overtone

Health Plans Punishing Members for Weight Loss

It’s an old problem. But it’s getting harder and harder to understand. When people lose a lot of excess weight and put obesity into remission, excess skin becomes a serious threat to health and well-being for many patients. However, health plans often tell patients, too bad. No matter what the medical need, the first response of most plans is to deny coverage. In essence, they’re punishing their members for weight loss.

Why? Because they can. Also, it saves them money.

Compelling Stories

If you want to understand the human dimensions of this problem, look to Lexi Reed. Through radical changes in her lifestyle, she lost 312 pounds from a starting weight of 485. She and her husband did it together. He lost considerable weight, too.

But all that weight loss left her with a daunting amount of excess skin. And pain. She describes it:

There were times when I didn’t know if I would wake up the next day because I was in so much pain.

One day we were in the bathroom, and my husband stood behind me and lifted my stomach so for the first time I could see what I would look like if my stomach wasn’t covering my hips and everything else. That was the first time that I didn’t feel the neck pain and all of the pain I had been feeling for months.

So, she’s done her research and found a surgeon who specializes in removing the excess skin after major weight loss – especially bariatric surgery. But, she says, her health plan will not cover it. “It’s expensive, but I refuse to keep living like this.”

Exploiting Blame and Shame

“This is my reality after living my whole life obese. I did this to myself,” she says.

Feeling that way is only natural in a culture that blames and shames people for their size. So it’s quite common. But self stigma is also quite harmful.

So finding that health plans will exploit internalized stigma to deny people medical care for excess skin after weight loss is deeply disturbing. OAC Chair Michelle Vicari explains:

Coverage is very inconsistent. Rarely will a health plan cover it on the first request. You must build your case with major documentation of rashes, skin breakdowns. In other words, they force you to suffer for a while. Then maybe, if you don’t give up, you might get an approval.

I had to pay for my own reconstructive surgery. And I had so much self-blame swirling in my head. Knowing the science of obesity has helped. Therapy and a few more years of age help, too.

In the end, I’m happy with my choice to have bypass surgery in the first place and thankful that I could afford some skin removal.

A Risk to Reputation

These tactics probably make sense for the health plan. At least for their profits. In the short term. But it makes no sense for a person’s health and well-being. So those profits come at a cost to a health plan’s reputation. For example, a California judge ruled in 2015 that Kaiser was systematically misleading patients about coverage of reconstructive surgery for skin removal. Such coverage is required under California law.

In other states, insurance plans might have an easier time keeping the burden on patients. However, that doesn’t make it right.

Click here to read more about the disabling problem of excess skin after weight loss and bariatric surgery. Click here to read more about Reed’s experience and here to read about yet another personal story.

The Antique Inheritance Tortures the Overtone, photograph © Michael Moore / flickr

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November 19, 2018