6 ms·

> When I was fat, my insurance wouldn't cover any weight loss procedure (including just visiting my primary physician to discuss my options for weight loss-- a

> When I was fat, my insurance wouldn't cover any weight loss procedure (including just visiting my primary physician to discuss my options for weight loss-- a lovely $250 surprise) because I had no obesity-related health problems (heart disease, diabetes, joint issues, etc). This is such a stupid, self-defeating policy for an insurer. Until your problem costs us a lot, don't you dare try to mitigate it on our dime!

ecommerceguy 4y ago
>> self-defeating policy for an insurer. Bariatric procedures can be included as a sort of "rider". This is typically written into self funded plans. Bariatric is not an essential coverage therefore ACA qualified plans do not typically include them - unless medically necessary.
aqme28 4y ago
In the US with healthcare tied to either employment or medicare, by the time these costs come around you're likely to either transfer out of this insurance or to the medicare option. Either way, it's someone else's problem (from the perspective of the current insurer).
SV_BubbleTime 4y ago
I don’t know, looking at the percentages… I’m not sure preventative care for obese people is sustainable at this point. Not that I shed tears for insurance companies, but I think this would be a lot of money. Now… the problem should have been addressed twenty years ago before it went critical.
njarboe 4y ago
After Obama Care, insurance companies profits are now capped at 8% (think that is the number) of revenue (ie premiums) in the US. So one way to grow revenue is to have higher costs per policy, pay out more, and charge higher premiums. If you are at 8% profit and you reduce your payouts as you are describing with preventative care, then you don't get to keep that money. You have to pay it back to the insurance buyers. Very perverse incentive.
- kurthr 4y ago
  The goal of the insurance companies is to make sure that all medical costs go up 10% every year so that their profits can increase and shareholders benefit. They are NOT negotiating lower pricing from medical providers, because why would they? Medical providers (and even individual care givers) have similar incentive structures to raise rates since they are paid only by insurance. The last local obstetricians were pushed into hospitals and large groups by insurance companies paying them 20-40% of prevailing fees. They now make more per procedure and don't have to pay for facilities or do billing. Why would the insurance company pay so much less? Because once the cartel is created their profit (and pricing) will double. That is for profit healthcare for you. Costs guaranteed to grow at DJI rates.
  - IG_Semmelweiss 4y ago
    >>>>>That is for profit healthcare for you. Costs guaranteed to grow at DJI rates. Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995. Yes, they have not raised rates...despite inflation That's true profit healthcare. What we have is a monster hybrid between government healthcare and subsidized, monopoly care
    - triceratops 4y ago
      Unfortunately no one is lobbying for a truly free market in healthcare. For instance, at all the supply-side restrictions on new physicians and hospitals. Limited residency spots, certificates of need whatever. Ideally the party in opposition to government-funded healthcare would do this.
    - gruez 4y ago
      >Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995. Source?
      - IG_Semmelweiss 4y ago
dangwhy 4y ago
> Until your problem costs us a lot, don't you dare try to mitigate it on our dime! I assume gp meant bariatric surgeries by 'weight loss procedure'. These are not just cost considerations , they come with significant risks and long term side effects. They aren't get out jail free card to be handed out like candy and isn't a 'preventive care' for obesity related diseases.
- PuppyTailWags 4y ago
  No. I was literally charged full price just for consulting with my family doctor about my weight. The doctor at the time referred me to a nutritionist; the nutritionist coverage was further denied because I had no qualifying health conditions. There was another option for weight loss medication, not the kind that affects hormones but makes the stomach feel full. These were also denied because I was just fat, not diabetic, heart problem, etc.
  - dangwhy 4y ago
    yea you might be one of those 'overweight but metabolically healthy' people. Despite the common misconception, you can infact live a healthy life even you are overweight if you are metabolically healthy ( ie. no insulin resistance)
    - deathanatos 4y ago
      Perhaps they are, perhaps they aren't. But it seems to me that the way to figure out whether they are or are not is by taking the very reasonable step that they took: a visit to their GP (and including following the doctor's referral to a nutritionist).
    - zdragnar 4y ago
      Metabolic health is not the only type of issue overweight people face. I suspect the real issue is that there are no universally proven ways to reduce weight that have high success rates of adherence - for example, this is why CPAP and insurance is really tricky... too many people wear them for a bit then stop using them, wasting thousands of dollars (between the sleep study and the equipment itself).
jancsika 4y ago
> This is such a stupid, self-defeating policy for an insurer. Quick, rank speculation: 100% of obese people don't go on to suffer from 100% of the potential risks of obesity. Given the actual percentages, it may be cheaper for the insurance company to pay for (and, at least in part, deny!) actual treatment for those potential risks than to cover the vast majority of preventative doctor visits and labs. Additional rank speculation-- I wonder if that problem gets worse as obesity numbers rise. E.g., symptom A necessitates a test for condition X, but symptom A plus obesity necessitates tests for condition X, Y, and Z...
Merad 4y ago
I'd be willing to bet that GP had a high deductible health plan. They leave you on the hook for 100% of your healthcare costs until you reach your deductible, unless your care is on a narrow list of things that they consider "preventable care." By insurer logic obesity is almost certainly an existing condition, even though treating it can prevent future healthcare complications. HDHP's are pretty perverse IMO.

ecommerceguy 4y ago

>> self-defeating policy for an insurer. Bariatric procedures can be included as a sort of "rider". This is typically written into self funded plans. Bariatric is not an essential coverage therefore ACA qualified plans do not typically include them - unless medically necessary.

aqme28 4y ago

In the US with healthcare tied to either employment or medicare, by the time these costs come around you're likely to either transfer out of this insurance or to the medicare option. Either way, it's someone else's problem (from the perspective of the current insurer).

SV_BubbleTime 4y ago

I don’t know, looking at the percentages… I’m not sure preventative care for obese people is sustainable at this point. Not that I shed tears for insurance companies, but I think this would be a lot of money. Now… the problem should have been addressed twenty years ago before it went critical.

njarboe 4y ago

After Obama Care, insurance companies profits are now capped at 8% (think that is the number) of revenue (ie premiums) in the US. So one way to grow revenue is to have higher costs per policy, pay out more, and charge higher premiums. If you are at 8% profit and you reduce your payouts as you are describing with preventative care, then you don't get to keep that money. You have to pay it back to the insurance buyers. Very perverse incentive.

kurthr 4y ago
The goal of the insurance companies is to make sure that all medical costs go up 10% every year so that their profits can increase and shareholders benefit. They are NOT negotiating lower pricing from medical providers, because why would they? Medical providers (and even individual care givers) have similar incentive structures to raise rates since they are paid only by insurance. The last local obstetricians were pushed into hospitals and large groups by insurance companies paying them 20-40% of prevailing fees. They now make more per procedure and don't have to pay for facilities or do billing. Why would the insurance company pay so much less? Because once the cartel is created their profit (and pricing) will double. That is for profit healthcare for you. Costs guaranteed to grow at DJI rates.
- IG_Semmelweiss 4y ago
  >>>>>That is for profit healthcare for you. Costs guaranteed to grow at DJI rates. Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995. Yes, they have not raised rates...despite inflation That's true profit healthcare. What we have is a monster hybrid between government healthcare and subsidized, monopoly care
  - triceratops 4y ago
    Unfortunately no one is lobbying for a truly free market in healthcare. For instance, at all the supply-side restrictions on new physicians and hospitals. Limited residency spots, certificates of need whatever. Ideally the party in opposition to government-funded healthcare would do this.
  - gruez 4y ago
    >Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995. Source?
    - IG_Semmelweiss 4y ago

dangwhy 4y ago

> Until your problem costs us a lot, don't you dare try to mitigate it on our dime! I assume gp meant bariatric surgeries by 'weight loss procedure'. These are not just cost considerations , they come with significant risks and long term side effects. They aren't get out jail free card to be handed out like candy and isn't a 'preventive care' for obesity related diseases.

PuppyTailWags 4y ago
No. I was literally charged full price just for consulting with my family doctor about my weight. The doctor at the time referred me to a nutritionist; the nutritionist coverage was further denied because I had no qualifying health conditions. There was another option for weight loss medication, not the kind that affects hormones but makes the stomach feel full. These were also denied because I was just fat, not diabetic, heart problem, etc.
- dangwhy 4y ago
  yea you might be one of those 'overweight but metabolically healthy' people. Despite the common misconception, you can infact live a healthy life even you are overweight if you are metabolically healthy ( ie. no insulin resistance)
  - deathanatos 4y ago
    Perhaps they are, perhaps they aren't. But it seems to me that the way to figure out whether they are or are not is by taking the very reasonable step that they took: a visit to their GP (and including following the doctor's referral to a nutritionist).
  - zdragnar 4y ago
    Metabolic health is not the only type of issue overweight people face. I suspect the real issue is that there are no universally proven ways to reduce weight that have high success rates of adherence - for example, this is why CPAP and insurance is really tricky... too many people wear them for a bit then stop using them, wasting thousands of dollars (between the sleep study and the equipment itself).

jancsika 4y ago

> This is such a stupid, self-defeating policy for an insurer. Quick, rank speculation: 100% of obese people don't go on to suffer from 100% of the potential risks of obesity. Given the actual percentages, it may be cheaper for the insurance company to pay for (and, at least in part, deny!) actual treatment for those potential risks than to cover the vast majority of preventative doctor visits and labs. Additional rank speculation-- I wonder if that problem gets worse as obesity numbers rise. E.g., symptom A necessitates a test for condition X, but symptom A plus obesity necessitates tests for condition X, Y, and Z...

Merad 4y ago

I'd be willing to bet that GP had a high deductible health plan. They leave you on the hook for 100% of your healthcare costs until you reach your deductible, unless your care is on a narrow list of things that they consider "preventable care." By insurer logic obesity is almost certainly an existing condition, even though treating it can prevent future healthcare complications. HDHP's are pretty perverse IMO.