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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]United Health care would not cover anything weight loss related. I am not diabetic. I am on Qsymia and I private pay.[/quote]

I don’t understand this.  A healthy weight prevents so many issues they’ll pay for down the road. I hope it changes. [/quote]

Agree.  I'm in primary care and have to deal (unsuccessfully, usually) with prior authorization and medical necessity.  _why_ BCBS, Aetna, etc. would push back against these prescriptions for long-time obese patients is truly beyond my understanding.

I mean, would BCBS rather pay for the looming type 2 diabetes that's right around the corner, guaranteed?  With its attendant chronic kidney disease, glaucoma and wounds?  Or how about the double knee replacements that are likely to come? Maybe Aetna and Cigna just really enjoy writing the checks for all the cancer treatments made necessary by obesity (colon, most breast, uterine, pancreatic).

It's really, really easy and straightforward to submit documentation that Jane Doe is obese and has one related chronic disease (even simple osteoarthritis). But the insurers fight even that!  A BMI of 35 is obese, full stop. Yet coverage is routinely denied on the first submission and sometimes on subsequent attempts.

They're shooting themselves in the feet, and I feel like there's a reason hiding in plain sight but I can't identify it.

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It’s probably more profitable to have people stay obese because they die sooner.[/quote]

They do not. That is my point. In the US, we are very, very good at keeping unhealthy people alive now with repeated expensive hospitalizations and interventions like dialysis, interventional cardiology & radiology, $400,000 / yr chemo, kidney transplant, surgery upon surgery for things like diverticulitis, colon resection, amputations, etc. They're shitty years, but they're years on Earth and the insurers are paying so much to patch up these 50-75 yr old obese people and keep 'em going. Well eventually Medicare takes over but you're mistaken if you think they all keel over before 65. Maybe in 1972 - not anymore. [/quote]

I understand what you said. Just because you work in primary care doesn’t mean that you’re privy to what goes into insurance assessment and all that. We’re both just speculating here. Everybody needs a ton of expensive care and intervention when they get old whether they’re fat or not. My own normal weight father has had two shoulder replacements and is currently on a medication that costs $12k a month that his insurance will be paying for the rest of his life. I have no doubt that overweight people are more costly in the latter years of their life but if those latter years are shorter it might still be cheaper. It is definitely possible that it is actually cheaper in the end to not treat obesity and that would explain why the insurances company are digging their heels in. [/quote]

As I said, I am not privy into the current calculations made by insurers and it's very confusing as a provider. I've also worked inpatient and these days, outside the oncology and trauma floors, the overwhelming %  of the admitted patients are obese. Wasn't always the case but it is now and I would have assumed that the big insurers would approach these new drugs they way they do statins, anti-hypertensives and things like metformin -- all designed to keep their clients from revolving door admissions[/quote]

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