Report Guides Those Seeking Help For Obesity

Attorney General Spitzer today released a report that provides tips to consumers for obtaining insurance coverage for obesity treatments.

"Obesity is a very serious health issue," Spitzer said. "Health insurance plans often create obstacles to proper treatment. The goal of this report is to help people overcome these obstacles and get the treatment they need to help avoid serious long-term health problems linked to obesity."

The report -- Focus On: Overcoming Obesity -- was developed in response to specific consumer complaints handled by the Attorney General's Health Care Helpline.

Most health insurance plans do not cover the cost of treating obesity because they do not consider obesity an illness, even though they cover the costs of treating the related problems such as diabetes, heart disease and hypertension. The small number of health plans that do cover treatments, such as gastric bypass and other bariatric surgeries, impose rigorous guidelines to prove that treatments are medically necessary. Obtaining approval for these treatments can be a lengthy and daunting process and many consumers simply give up without receiving the help they need.

The report advises consumers to take specific steps to increase their ability to secure coverage for obesity treatment, including:

  • Contacting the insurance plan early in the process to get clinical review criteria so that patients know the rules ahead of time;
  • Keeping detailed medical records to present to the health plan when requesting treatment authorization; and,
  • Filing an appeal any time coverage is initially denied.

The report acknowledges the work of the New York Health Plan Association's Obesity Surgery Project to develop standardized guidelines to evaluate whether such surgery is appropriate.

Obesity is a major public health issue. More than 60 million Americans, nearly one in every six, are obese. More than 9 million are considered morbidly obese, meaning they are at least 100 pounds overweight.

A 2002 report by the National Center for Chronic Disease Prevention and Health Promotion, a division of the Centers for Disease Control, revealed that 57 percent of New Yorkers are overweight or obese and that the obesity rate among New York State adults doubled between 1990 and 2002. The report also stated that 28 percent of New York high school students are overweight or at risk of becoming overweight.

Focus On: Overcoming Obesity is the second in a series of periodic reports issued by the Attorney General's Office documenting specific problems that consumers face in the health care system. An earlier report -- Focus On: Eating Disorders – was released in February.

The full text of Focus On: Overcoming Obesity is available on the Attorney General's website: www.ag.ny.gov. The report was written by Annie Siegel and edited by John Rice of the Health Care Bureau.

Consumers and health care providers with questions or concerns about health care matters may call the Attorney General's Health Care Bureau Helpline at 1-800-771-7755 (option 3).

Attachments:

  • Report on Obesity  PDF

For Adobe PDF files you can download Adobe Reader from Adobe Systems.

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