Talking with Your Employer about Insurance Coverage of Obesity Treatment

Many commercial insurance plans don’t have coverage for comprehensive obesity treatment and exclude anti-obesity medications (AOM’s). This is frustrating for me (Dr. Andrick) and a majority of my patients! It doesn’t make sense when so many other weight related conditions can be improved or prevented with weight reduction.

How can we change the system? People making their voices heard and advocating for themselves and others is the only way! Here are some Talking points and Tips when you are addressing your employer, Human Resources or Employee Health at your company or your legislators.

Identify the Source-Who in the company is responsible for choosing health benefits? Identifying these entities or individuals will allow you to proceed with our request for improved benefits for the treatment of obesity.

Costs- Obesity is associated with increased absenteeism, illness, disability, mortality and use of health care, resulting inlost productivity. Since 25% of Colorado adults have obesity (59% overweight and obesity), a company can cut costs by treating obesity with a combination of care options, including AOM’s.

Indentify Influential Advocates- Seek someone with influence, possibly even someone with obesity to advocate for comprehensive obesity care.

Form Alliances- Find co-workers with obesity to join with you in advocating for coverage .Request a meeting with the person responsible for insurance choices.

Employee Retention- A competitive benefits package most likely to attract and retain employees would contain a Chronic Care Benefit that encompasses treatment of obesity including anti-obesity medications. Companies often tout their Wellness Benefits and why wouldn’t it include coverage for obesity treatment?

“Carve-Outs”- Companies may opt out of including coverage for obesity care without realizing this by choosing a plan with a discriminatory benefit design- one that may intentionally “carve out” obesity treatment, even when medically necessary. urge your company to choose a plan that provides coverage for chronic disease management including obesity care.

Inequities- Federal and Colorado state employees and veterans now have comprehensive obesity care. While a large majority of state employee health plans and Medicaid programs provide coverage for obesity counseling and bariatric surgery, many still do not offer coverage for AOM’s. If your plan lacks coverage for medications, point out the inequity of these state plans or commercial plans non-coverage of these medications. Point out the racial and socio-economic inequities-obesity affects minorities and people with lower incomes the most and these are often the same people who can least afford AOM’s. (May want to speak with DEI or Equity Officer if your company has these).

Bariatric Surgery- Bariatric surgery is a proven treatment for obesity-particularly for those with severe obesity. Medications are also an effective and safe treatment avenue for those who may be hesitant about surgical intervention. Ask why surgery is covered by AOM’s are not.

Typical Reasons for non-coverage of AOM’s-

Weight Bias! Obesity is caused by a lack of will power and is the fault of the person who has it. AOM”s are a ‘crutch ‘ for the weak-willed. This is of course nonsense, obesity is a chronic disease with a complex array of causes and contributors that are not the fault of the person.

Weight Recurrence-People gain weight when the AOM is stopped, which is often taken to mean they don’t work. The real reason meds are required to keep weight off, again obesity is a chronic, relapsing disease and like other chronic diseases (diabetes, heart disease, high blood pressure), it requires long-term use of medication.

Myths- “AOM’s are dangerous”-This stems from misinformation in the media and abuse of non-FDA approved substance that were dangerous or ineffective. Current AOM’s are FDA-approved, well-studies, safe and effective with some averaging 15-20% body weight loss.

The most powerful and impactful statements your can make are the ones you share of your own story!