Thanks to provisions in the Affordable Care Act passed on January 1 of this year, your insurance may now cover nutrition and obesity screening and counseling, which could help you learn to eat better, lose weight and gain control of your health.
Sounds great, right?
Unfortunately, some providers are doing more for their pocketbooks than for their patients.
“People see a quick fix, and there are unscrupulous individuals out there ready to take advantage of that,” says OnTrack Diabetes Editorial Board Member Amy Hess Fischl, MS, RD, LDN, a certified diabetes educator and program coordinator for the Teen and Adolescent Diabetes Transition Program at the University of Chicago’s Kovler Diabetes Center. “The key is evidence-based medicine, and some of the unproven methods clinics are using could be dangerous and will not lead to successful weight loss.”
A July article in The New York Times reports the rapid expansion of for-profit diet clinics overseen by doctors—and the potential for abuse that comes with it. In this lucrative business, poised to grow 5 percent a year through 2019, according to market analysts, doctors are charging in the neighborhood of $1,199 for weight-loss programs, only a sliver of which is covered by insurance. Doctors stand to earn some $3,000 from each obese patient they treat, according to promotional materials for Obesity Management Systems, a new consulting business that teaches primary-care doctors how to bill insurers for obesity treatment. What’s worse, the article notes, pricy treatments often include trendy therapies such as vitamin injections, supplements and extreme diet plans that simply haven’t been proven to work.
The solution is not to simply steer clear of screening and counseling, which could be a life-saver for people struggling with obesity and its complications, including diabetes, as well as hypertension, sleep apnea, heart disease and other serious conditions. The challenge is to learn which benefits your insurance covers and to find reputable providers. If you have diabetes, Hess Fischl notes, most insurance companies will cover obesity-related services (note that you must be over age 18 and have a BMI of 30 or greater).
Here, Campoy-Gonzalez and Hess share five guidelines to consider before opening your wallet for a weight-loss plan:
1. Ignore advertisements. Resist come-ons for a free initial consultation or a special deal, which is often bait for a pricy program. Instead, ask your primary care physician for a referral, or reach out to the American Board of Obesity Medicine, the American Society of Bariatric Physicians, or The Obesity Society, all of whom have directories of physicians specializing in obesity care. You’re looking specifically for a center that specializes in “bariatric medicine,” which is the medical management of obesity as a chronic disease. Services should include behavior modification, medical nutrition therapy, physical activity counseling, pharmacotherapy, and other non-surgical interventions.
2. Make sure the doctor works with a nutritionist. Not all doctors are trained in nutrition or are experts on weight management, especially when it comes to helping people change their eating habits—arguably one of the most important pieces of this puzzle, warns Hess Fischl. Make sure that your physician is working closely with a team that includes a registered dietitan nutritionist (RDN) and a nurse who is trained in nutrition. Studies show better weight-loss outcomes when nutritionists are involved in the treatment.
3. Don’t feel compelled to buy pre-packaged meals. They may work for certain people, especially those who have trouble with portion control, but they can get very expensive, Hess Fischl says, and you can always pre-portion your own foods. In fact, there’s no better way to learn how to recognize a standard portion size than by measuring and weighing food yourself in your own kitchen. Those skills will help you continue your good eating habits long after the Jenny Craig boxes are gone. “Using the ‘My Plate’ method of achieving healthy eating is the best recommendation available,” Dr. Gonzalez-Campoy says.
4. Skip the quick fix. If a clinic’s plan includes supplements, vitamins or vitamin B12 injections, move along. “Unless someone has a disorder that causes a deficiency, is a vegan or taking Metformin, a medication for diabetes, the likelihood of a B12 deficiency is remote,” Hess Fischl says, “and without a deficiency, it will not aid in weight loss.” She doesn’t recommend taking any supplements that promise to help you shed pounds. “If it sounds too good to be true, it probably is,” she says. Dr. Gonzalez-Campoy warns against clinics dispensing any pills without first taking a thorough history and doing a physical exam.
5. Never pay cash upfront before getting any services. Most cash upfront clinics sell products—like Optifast, Medifast, and other very low calories meal plans—are more a promise for immediate results than what patients really need, which is long-term care for a chronic disease, Dr. Gonzalez-Campoy explains. “So never pay up front for a promise to lose weight, especially if the promise is with something other than an FDA-approved weight loss medication,” he adds.
A cash outlay also increases the chances that you’ll end up paying out of pocket for a service that might be covered by insurance entirely or at least reimbursed. (Because once the clinic has your money in hand, they may “forget” or neglect to send a bill to your insurer, and you may not remember to follow up, especially if you trust them to do the right thing.) Instead, go online and see if your insurer provides an explanation of what's covered. Or, prior to agreeing to any services, present your insurance card to the clinic and then wait for them to send you an explanation of benefits by mail (it may take a few weeks.) Some insurers will also provide this information online or by phone. Again, never pay cash upfront unless it’s for an approved weight loss med, or a small copay—and even then, try to use a check or credit card so there’s a paper trail.