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Since 2012, many U.S. states have expanded their health care coverage for treatments of obesity. A few of these programs also make allowances for diabetes treatment.
Gastric Bypass Surgery for Morbid Obesity
As of the year 2012, the U.S.A.’s Affordable Care Act (ACA) has allowed for states to choose an existing insurance plan to serve at that state’s so-called “Benchmark Plan.” The purpose of this was to move toward more uniform insurance coverage nationwide. States that did not choose a Benchmark Plan were given such a plan chosen by the U.S. Department of Health and Human Services as a default.
As things stood in 2015-2016, 33 states had one of two types of coverage for the diagnosing and treating of obesity as a medically-defined disease. Twenty-three states now require insurance policies to cover gastric bypass surgery. Gastric bypass surgery is a method for reducing the size of a person’s stomach so that he or she has a reduced appetite and a reduced urge to eat.
Gastric bypass surgery is one of several surgeries for weight loss that fall under the general term of bariatric surgery. The three main kinds of bariatric surgery are gastric bypass, gastric sleeve, and gastric band. Gastric bypass reroutes food so that it bypasses the stomach and goes directly into the intestines, gastric sleeve makes the stomach smaller, and gastric band uses a device to temporarily make the stomach smaller. The two former methods also affect the hormones that control the sensation of hunger, though gastric band surgery does not.
Twenty-three states is up significantly from the 5 states that offered coverage of morbid obesity before the ACA. An additional three states (Indiana, Virginia, and Georgia) have at least some policies on offer that cover gastric bypass surgery, although these states do not require this coverage on all of their policies.
Nutritional Therapy/Nutritional Counseling.
Twenty-three states now cover some form of nutritional counseling and/or therapy. Of these, 7 states cover only nutritional counseling or therapy related to diabetes. An additional 16 states offer some policies that cover or reimburse for counseling or therapy for obesity, dietary or nutritional screening, and sometimes weight loss programs.
Additional Requirements of the ACA
Beginning on January 1st of 2014, the ACA has required that insurance coverage of obesity screening for children and adults does not involve any cost-sharing. Cost-sharing methods are those that split the cost of services between the consumer and the insurance company. These include annual deductible amounts, enrollee co-payments, and co-insurance. All 50 states now require that insurance companies fully cover child and adult obesity screening.
In addition, it is no longer legal for insurance companies in all 50 states to charge consumers a premium surcharge for obesity. All insurance policies, including those sold through ACA exchanges, must follow this prohibition.
Consumers who have questions about what procedures, tests, and services are covered under their individual health care policies are advised to contact either their state insurance department or their individual health care providers. In most states, the state insurance department is responsible for overseeing the application of federal mandates to state-specific reimbursement and coverage.