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- Your weight often determines what your premium will cost, and some insurance companies refuse to offer policies if you are obese. However, plans offered through the Obamacare marketplace cannot deny you coverage for pre-existing conditions
- Many health insurance companies do not cover treatment for obesity
- Since weight problems and obesity cause a myriad of medical related issues, insurance companies charge more for coverage for those considered overweight or obese
- Physicians use the body-mass-index calculation to determine if you are obese. A BMI of 25 to 30 is overweight, and doctors consider anything over 30 obese. Here is a reliable BMI calculator from the Centers for Disease Control and Prevention
Health Insurance Costs and Your Weight
It is no secret being overweight or obese exacerbates plenty of health-related issues. For that reason, many health insurance companies charge more for coverage assuming you will need more medical services than a healthy person.
Many companies offering individual health insurance plans tightened their requirements for receiving the best premiums and coverage. However, individual insurance plans offered under Obamacare do not charge higher premiums if you are overweight or obese.
Under Obamacare, no plan can charge you more in premiums or refuse to pay if you have a pre-existing condition, and obesity falls under the definition of a pre-existing condition.
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Obesity Treatment and Your Health Insurance Company
Your health insurance provider has a reason to help you stay healthy by offering treatment for obesity. Being overweight or obese leads to costly medical problems such as diabetes, heart disease, some forms of cancer and a higher risk of heart attack or stroke.
Many health insurance plans do not offer coverage for weight-loss treatment. Insurance companies will pay for health problems related to weight problems after they begin, but they normally do not pay for treatment that helps you lose weight.
The health insurance companies and their policies on treatment for obesity are not universal nor is it set in stone.
What you can do is bring to the attention of your policyholder the costs of medical problems associated with obesity and how treatment for obesity will reduce those costs in the long run.
By pointing out the benefits of treatment as opposed to just treating weight-related health problems, some companies may offer to reimburse you for obesity treatment.
Communication With Your Health Insurance Company About Obesity
Your health insurance provider may be hesitant at first to offer you any form of reimbursement for obesity treatment, even if your doctor prescribes or recommends the treatment. The company’s policy should not prevent you from starting communications with your provider and pointing out that obesity is a chronic medical condition and treatment saves money in the long run.
Some providers do not recognize obesity as a chronic medical condition when compared to other conditions like high blood pressure or diabetes. Instead, many companies look at obesity as a lifestyle choice.
Obesity in America
The United States is suffering from an obesity epidemic with one in three Americans considered obese, according to the American Heart Association. Over 78 million people in the U.S. deal with the physical effects of obesity and the numbers continue to drive health-related expenses to record-breaking highs.
An op-ed piece in Time magazine from Sep. of 2016 stated that the consequences of obesity result in the deaths of 400,000 Americans each year with an annual estimated cost of $190 billion, which is 21 percent of all health-related spending.
Over the past 35 years, obesity has risen from an average of 15 percent of the population to a staggering 35 percent of the population. The statistics represent a troubling trend: both in the diagnosis and treatment of obesity and the way insurance companies handle obesity coverage.
Many insurance companies do not provide enough in the way of financial incentives for doctors to focus on obesity prevention and treatment. It goes back to the way many insurance companies look at obesity (as a lifestyle choice rather than a medical condition).
This thought process on the part of health-care providers is crucial if you are overweight or obese and you are comparing health insurance companies and their policies on obesity. As of 2014, the Affordable Care Act prohibited insurance companies from requiring obese patients to pay a premium surcharge.
In addition, insurance plans in every state must cover certain services related to obesity, such as obesity screening, without charging an annual deductible amount and no cost sharing. These requirements also included plans offered through the health-care exchanges.
For specific coverage information on obesity, contact the insurance carrier directly, or you can contact your state’s insurance department.
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