Access to Care, Hurdles to Health

Hundreds of people are gathering for the annual Your Weight Matters Convention in Tampa this weekend. But before the event started, an impressive group of activists gathered yesterday. They came early for the latest in training for advocacy. It’s vital work for the OAC. The work is necessary because health plans (insurance companies) create hurdles to health for people with obesity. It’s systematic and it’s pernicious.

Medically Unnecessary Requirements

Perhaps the most galling rigamarole is the procedures that plans have for approving people who need surgery. Most of the people – as much as 99 percent – who need bariatric surgery never get it. Some of them are understandably reluctant to undergo a major surgical procedure. Others don’t have coverage. But still others are daunted by the hurdles that “health” plans put in the way of getting clearance for their operation.

The most grievous example is the medically unnecessary requirement for pre-op weight loss. Insurance companies will routinely ask people who need surgery to spend six months in one more weight loss program. Why? Just because.

The fact is that it’s medically unnecessary. Systematic reviews tell us that it has no benefit for the patient. It has no impact on outcomes. It’s just one more hurdle. A tool for making some people give up.

Hypocrisy and Risk

But here’s the revealing aspect of all this. Health plans generally demand that patients pay for these pre-op programs themselves. Because it’s not medically necessary.

Health plans themselves won’t pay for medically unnecessary bunk. But if it’s on the patient’s tab, why not? It’s simply a hurdle that will make some patients stop and give up. They’re good with that.

Worse than the hypocrisy is the potential for added risks. A recent study of 349,016 cases found that these requirements could lead to higher infection rates and thus, added risks for patients. The ASMBS is unequivocal that this requirement is unethical:

It contributes to patient attrition, causes unnecessary delay of lifesaving treatment, leads to the progression of life-threatening co-morbid conditions, is unethical, and should be abandoned.

OAC Action

Does your health plan have these unethical requirements? If not, good for them. Many plans are abandoning this abhorrent practice. But if yours is lagging behind, ask your health plan administrator. OAC stands ready to challenge these harmful practices.

Click here and here for some of the latest perspective on this subject.

Hurdles, photograph © Phil Roeder / flickr

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August 2, 2019