Weight Loss Treatments Leave Insured Patients With Fat Bills

Melissa Moss, after trying unsuccessfully to lose weight by dieting, eventually managed to take off 45 pounds. The key was enrolling in a program that provided behavioral and nutrition counseling, a physician-supervised low-calorie liquid diet and group therapy.
But The Washington Post reported that Moss, 24, an accountant in Washington, D.C., who earns $15 an hour, was left with more than $4,000 in credit card debt that she ran up paying for the program, which her insurer refused to cover.
“Insurance companies say they want you to be healthy, but they won’t pay for treatment,” said Moss, who was urged by her doctor to lose weight. “It’s frustrating that they want you to be as sick and disabled as possible before they will help.”
That problem, the Post said, is common to millions of Americans battling fat whose insurers refuse to pay for obesity treatments but cover the expensive health consequences of the extra weight.
With obesity on the rise — two-thirds of American adults are overweight or obese — a few insurers have begun in recent years to pay for some weight loss options.  A spokesman for America’s Health Insurance Plans, an industry trade association, said that the practice was not yet widespread because data about what works have “only emerged in the last few years. Obesity is definitely an evolving area.”
In fact, a team of George Washington University researchers reported in a recent study that many states allow insurers to charge obese patients higher premiums or deny coverage of the condition.  Meanwhile, they also found that only eight state Medicaid programs cover all of the following treatments:  assessment and counseling, drug therapy and surgery to combat obesity.
Some changes may be coming soon, however. Provisions in the new health care overhaul law that take effect Thursday will require insurers to cover obesity screening and behavioral counseling by physicians. Key details, however, remain to be worked out.

Hunting for health insurance? Do your research

The new health care law promises help for people who cannot rely on an employer-based plan to cover their insurance needs. But that doesn't start until 2014, and millions are expected to need individual plans in the meantime.

Many should be able to find what they need by doing some research, asking the right questions about coverage and using some government help that's already available. Here are basic steps to take before choosing a plan:

— Think about your needs.

Consumers can't find a policy that suites them unless they understand what they need. If you see the doctor frequently, a plan that limits those visits to four times a year would not be wise. But that could be an option someone in his 20s who rarely gets sick.

Likewise, a plan that doesn't cover pregnancy wouldn't be smart for people who want to start families. Some options only cover generic drugs, and that means big pharmacy bills for someone who depends on a brand-name prescription medication.

"Once you can identify what the health insurance needs are . that will kind of dictate what your monthly premium will be," said Keith Mendonsa, a consumer health insurance specialist with eHealthInsurance, an online insurance broker.

Before searching for insurance, think about whether you can be added as a dependent to the existing coverage of a spouse or parent.

— Do some research.

Premiums, or the price of an insurance policy, vary widely depending on variables such as age, health, where you live and how you want your coverage set up. One place to start sorting options is the website www.healthcare.gov , which is managed by the Department of Health and Human Services.

The site walks consumers through plan design, helping them find coverage options based on their states and other factors that could affect their rates. It was put together by people who "care about actually being useful to consumers," said Nancy Metcalf, a senior program editor with Consumer Reports who is not involved with the site.

"All of the policies you are going to see are going to be decent policies, and they'll also say if some stuff isn't covered," she said.

— Consider a broker.

Licensed insurance brokers can help customers quickly sort through their options, and they can be especially useful for people who have pre-existing conditions. For people with diabetes or recovering from cancer, finding individual coverage can be difficult or impossible depending on the state in which they live.

Some people also can be turned down because they take high-blood pressure or cholesterol medicine or they recently had hip surgery, Metcalf said. Brokers know which insurers will reject certain conditions, which can save some grief.

— Look closely at coverage details.

Most policies contain a summary of key numbers. Consumers should examine at least five: the premium, deductible, co-payment, coinsurance and the maximum amount the policyholder can expect to pay out of pocket each year.

The deductible is the annual amount a patient pays for care before coverage starts. High-deductible plans come with lower premiums.

Coinsurance is the percentage a patient pays for medical care generally after a deductible is met. These percentages mean you still could wind up with a big bill for a surgery even if you have good coverage and you've met your deductible.

The annual maximum is how much you have to spend on coinsurance and other costs before the insurer takes over and covers the majority of your remaining expenses for the year.

"This is your maximum financial exposure, and it's a big deal," Mendonsa said.

— Be careful

Make sure you understand all the coverage specifications before you pay for a policy. You also should know if your doctors are in the insurer's network because it will cost a lot more for care and visits if they are not.

It also pays to understand hospital coverage and the limits a plan places on it.

"You don't want to be blindsided," Metcalf said.

3M to end retirees' health plan

3M Co. said it will soon stop offering its company health insurance plan to retirees, giving them a sum of money to shop and buy insurance on the open market instead.
The Maplewood-based maker of Post-it Notes and Scotch Tape said it is making the change in response to the new health reform law.
"Health care options in the market under the health care reform law became better," said spokeswoman Jackie Berry, adding that taking retirees off the 3M group plan would save money for both 3M and retirees.
The move is part of a longer-term trend by employers to get a grip on the ballooning costs of retiree benefits. Most employers already have done away with the rich pension plans of the past and switched to 401(k) plans, under which they limit their exposure to future costs.
3M may be one of the first large employers to take this step in response to health reform, but it's not likely to be the last.
"I suspect they're ahead of the game in terms of arriving at this decision," said Henry Van Dellen, who heads the health and benefits practice at Aon Consulting. "Practically speaking, this likely will happen with a lot of employers."
3M retirees started receiving letters about the changes last Friday.
The company has about 23,000 U.S. retirees. Berry couldn't say how many would be affected by the change, nor could she say how much retirees might expect to save.
In 2008, 3M announced changes to its pension program, changing it from a defined-benefit plan to a defined-contribution plan. It also changed its retiree medical plan so retirees would get an account with a credit they could use to buy into the 3M group plan.
Those changes took place in 2009.
The changes announced last Friday build on those changes. Starting Jan. 1, 2013, 3M retirees eligible for Medicare will get a health reimbursement arrangement: an account with credit in it to buy a Medicare supplement plan or a prescription drug plan

How to pick a good plan

In 2014, the major provisions of the new health-care law kick in. Insurers will be required to offer comprehensive plans and accept all customers regardless of any preexisting conditions. All Americans will be required to have health coverage (subsidized for lower-income households) except in cases of severe financial hardship.
Until then, though, insurers can operate by many of the old rules. You'll want to avoid plans that are thin on coverage, exclude certain services or refuse to publicly report on consumer satisfaction and health-care outcomes.
Here are ways to evaluate a health-insurance plan:
l Make sure everything's covered. Insurance should cover hospitalization, doctor visits, emergency services, diagnostic tests and prescription drugs. Verify that there are no major exclusions listed.
l Ask your employer. Your human resources department may be able to help you choose an appropriate plan.

l Consult HealthCare.gov, a site managed by the federal government. Some 5,500 products from about 1,000 insurers are listed by state. The site is scheduled to add cost information and plan-comparison tools as of October.

l Run the numbers. With the employee share of group insurance continuing to rise, your job is to select a health-insurance plan that balances cost, coverage and quality of care. One basic trade-off to consider is this: A higher deductible or out-of-pocket limit can lower your monthly premium.