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Does Your Company Offer Weight Loss Surgery Insurance?

Posted on 07/01/2014 at 11:58 PM by Todd Eibes, MD

Weight Loss Surgery InsuranceVery much related to the current national debate, employer sponsored weight loss surgery insurance is a growing concern for businesses across the country.

The national epidemic of obesity presents significant problems for employers. Obesity and its related conditions contribute to lost productivity, wage replacement and increasing medical costs, all of which impact a business’s bottom line.

More than one-third of American adults are obese, and that figure continues to rise. Currently, health care spending due to obesity is approximately 21% of total health care spending.

According to the Center for Disease Control (CDC), chronic diseases such as arthritis, diabetes, and heart disease, which are linked to obesity, account for 75% of national health care expenditures. The CDC projects, if trends continue, that obesity rates will double by 2030 and rise even higher in some states, increasing expected spending by $48–$66 billion.

Overweight employees cost their employers $73.1 billion a yearand file twice the number of workers’ compensation claims. The average medical claims cost per 100 employees is 7.3 times great for obese employees versus for the non-obese.Obese men take six more sick days a year and obese women take 9.4 more than their non-obese counterparts.

The resulting obesity-related absenteeism costs employers about $6.4 billion a year. Indirect costs including increased absenteeism, disability, and workers’ compensation compound the problem.

Weight loss surgery insurance is cautiously being embraced by employers who believe that paying for the surgery may be worth its high initial cost. Research proving the dramatic health benefits for people who successfully undergo weight loss surgery, the reduction in obesity related conditions such as type 2 diabetes, heart disease, sleep apnea, and cancer, as well as improvements to post-surgery care to reduce complications, makes employer sponsored weight loss a worthwhile investment.

If you are considering weight loss surgery, review your employer’s Medical Benefits Summary Plan Description (SPD) to determine if the procedure is covered. If it’s not covered, you may be able to negotiate coverage with or through your employer.

Before beginning this process, you should determine what type of insurance plan your company offers. There are two types: self-funded and fully insured plans. Medium to large size companies often provide self-funded health insurance plans. In this case, the employers decide which health services and procedures are covered for their employees and dependents.

If coverage is not available under a self-funded plan, consider providing your employer’s benefits manager information about the organizational impact of offering weight loss surgery insurance, and request that it be added to the company’s health plan.

Coverage under fully insured plans is determined by the insurance company administering the health benefits. If coverage is available, information will be included in the policy’s Certificate of Coverage. If weight loss surgery insurance is not offered, your employer may agree to advocate on your behalf for coverage with the insurance company.

Regardless of how your health insurance plan is funded, securing weight loss surgery insurance can be a time-intensive process requiring several meetings with your benefits manager.

You may want to prepare for these meetings by reviewing information about morbid obesity and associated health conditions, as well as the many health benefits associated with weight loss surgery, such as gastric banding, gastric bypass, and laparoscopic sleeve gastrectomy.

Questions you should ask your benefits manager:

  • Can you assist me and/or my weight loss surgeon in determining if weight loss surgery can be covered under the self-funded insurance plan?
  • Is weight loss surgery an excluded service under our self-funded insurance plan?
  • What information about obesity and weight loss surgery would you need to make an exception?
  • Will you work with my weight loss surgeon and/or weight loss program coordinator regarding weight loss surgery coverage?
  • If a form is required, where can it be accessed?
  • Where, and to whom, should the information be sent?
  • What are the deadlines for submitting an appeal?
  • How long will it take to make a determination weight loss surgery will be covered?
  • Are there any preoperative or postoperative services not covered?

When you speak with your benefits manager, it’s important to come prepared with a list of benefits of weight loss surgery and the impact it would have for both your employer and you. Be prepared to share your story, your medical history, and any other helpful information about the positive impact such coverage would have on you as an employee and for the company as a whole.

The benefits manager can share this information with the appropriate decision makers who will make the final determination as to whether or not weight loss surgery will be covered by your employer’s health plan.

If you’re interested in learning more about:

  • Dr. Todd Eibes
  • Iowa Weight Loss Specialists
  • Our West Des Moines location
  • Our weekly informational class
  • Weight loss surgery financing
  • Or would like to schedule a consultation

Please call 515-327-2000 or email us.

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