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What's covered, what's not
by Jeff Horwich, Minnesota Public Radio
June 2, 2003

MPR asked the largest health insurance providers in the state for information on their policies toward covering obesity-related treatments. Their responses are outlined here.

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Providers who responded:

HealthPartners
Blue Cross and Blue Shield of Minnesota
Preferred One
Medica
State of Minnesota

Definitions used below: "Obese" = BMI of greater than 30; "Overweight" = BMI between 25 and 29.9; Other members = BMI of less than 25. "Separate risk factors" might include glucose levels, diagnosed diabetes, family history, prior heart maladies, etc.

This survey is generic in nature. Each individual patient's case may be different and responses to this survey should not be interpreted as a guarantee of coverage.

Where a physician recommends it, do you regularly provide coverage of:

1. "RGB" gastric bypass surgery?

Option	Obese	Overweight	Others
HealthPartners	Yes*	No	No
Blue Cross	Yes*	No	No
Preferred One	Yes*	No	No
Medica	Yes*	No	No
State of Minn	Yes*	No	No

(*For BMI of 40 or greater, or 35 to 39.9 with certain risk factors)

2. Gastric banding or "VBG" bariatric procedures?

Option	Obese	Overweight	Others
HealthPartners	Yes*	No	No
Blue Cross	Yes*	No	No
Preferred One	Yes*	No	No
Medica	Yes*	No	No
State of Minn	Yes*	No	No

(*For BMI of 40 or greater, or 35 to 39.9 with certain risk factors)

3. FDA-approved prescription obesity drugs (e.g. Xenical)?

Option	Obese	Overweight	Others
HealthPartners	Yes	No	No
Blue Cross	Yes	Yes*	Yes*
Preferred One	Yes	No	No
Medica	Yes	No	No
State of Minn	Yes	No	No

(*with certain risk factors)
(Prescription obesity drugs used primarily as appetite supressants are generally not covered)

4. Weight loss food substitute regimens (e.g. OptiFast)?

Option	Obese	Overweight	Others
HealthPartners	No	No	No
Blue Cross	Yes	No	No
Preferred One	No	No	No
Medica	No	No	No
State of Minn	No	No	No

5. Meetings with an approved nutritionist?

Option	Obese	Overweight	Others
HealthPartners	Yes	Yes	Yes
Blue Cross	Yes	Yes	Yes
Preferred One	No	No	No
Medica	Yes	Yes	Yes
State of Minn	Yes	Yes	Yes

6. Other approved "behavior modification" fitness programs or counseling?

Option	Obese	Overweight	Others
HealthPartners	No	No	No
Blue Cross	No	No	No
Preferred One	No	No	No
Medica	No	No	No
State of Minn	No	No	No

7. Participation in other independent weight loss options (e.g. Weight Watchers, Curves for Women, health club memberships)?

Option	Obese	Overweight	Others
HealthPartners	No	No	No
Blue Cross	No	No	No
Preferred One	No	No	No
Medica	No	No	No
State of Minn	No	No	No

8. Physicians appointments to diagnose/discuss weight issues/obesity?

Option	Obese	Overweight	Others
HealthPartners	Yes	Yes	Yes
Blue Cross	Yes	Yes	Yes
Preferred One	Yes	Yes	Yes
Medica	Yes	Yes	Yes
State of Minn	Yes	Yes	Yes

Has your coverage in any of these areas changed significantly in the past two years? Five years? Ten years?

Option	2 years	5 years	10 years
HealthPartners	Yes	No	No
Blue Cross	No	No	No
Preferred One	No	Yes	Yes
Medica	Monitored regularly	n/a	n/a
State of Minn	No	No	n/a

Does your coverage of obesity/weight management differ in any general way between adults and children?

Option
HealthPartners	n/a
Blue Cross	No
Preferred One	No
Medica	No
State of Minn	No

(A summary of information on weight control and obesity treatments covered by Medicaid and Medicare is available at www.obesity.org, and The Centers for Medicare and Medicaid Services at the U.S. Department of Health and Human Services.)

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