Larissa P.
More on the battle to get HR to include WLS in new health plans
Sep 09, 2008
Ok, see my blog for my history with working with HR. Sometimes I'm confident it will work, other times I feel hopeless...!!!This is the latest in some communication with HR regarding upcoming insurance changes:
HR director to company employees:
As you know, we are in the process of combining our benefits offerings.
....
We are working on our medical renewal and have narrowed it down to Anthem Blue Cross and UnitedHealthcare. We plan to offer one carrier (either Anthem or United) with two choices. The choices will be a traditional PPO (Preferred Provider Organization) and a (CDHP) Consumer Driven High Deductible Plan.
....
More information will be shared over the next weeks and your feedback is welcomed.
Me to HR Director:
I’m very pleased to hear this as both these companies were my top choices, too. Dare I ask if coverage of the medical treatment of obesity is still on the table…?
HR director to Me:
Thanks for the feedback. Medical treatment of obesity is on the table to be covered differently than it currently is (I think you’re asking about the surgical treatment options) - and we’ll see. Unfortunately cost will come into play at some point.
You know you’ll hear more from me…
WELL...that scared the bejeebus out of me, so I replied:
Me to HR Director:
I bet that wouldn’t be an issue if an employee had cancer from smoking. :(
HR Director to ME:
Actually we are looking at different premium rates if someone commits to not smoking – trying to make sure we can get it set up in HRB . ..
Me to HR Director:
I don’t smoke! lol
And I will be HAPPY to pay a higher premium for my weight (although – you wouldn’t make someone with breast cancer pay a higher premium – and I believe both are genetic and not lifestyle issues) if it meant I would get coverage.
HR Director to Me:
I hear what you’re saying and respect your desire ..one part I’m struggling with is that this is an additional cost to everyone on the plan – not just one person…
I’m glad we’re able to talk about it openly…
I can’t tell you how comforting it is that an HR department would keep an open dialog with an employee.
On that note – I’m going to just leave you now with a few more points:
1. >>>Studies show not only is bariatric surgery a proven medical procedure with an outstanding track record, but it is cost effective in as little as two to four years.
“The analysis covered six months of presurgical evaluation and care, the surgery itself and, on average, about 18 months of postsurgical care, including costs incurred from surgical complications. Some patients' postsurgical claims were tracked for up to five years. Costs included payments for prescription drugs, physician visits and hospital services. Claims were monitored for obese patients who didn't have surgery over the same period.
The study showed that insurers fully recovered the costs of laparoscopic surgery after 25 months. Laparoscopic surgery is a less-invasive version of gastric bypass with an average cost of $17,000. Between 2003 and 2005, the break-even point was reached in 49 months for traditional bariatric surgery, which carries an average cost of $26,000.”
Source:
2. >>> Having said that, many experts wonder why surgery for one disease has to prove cost effectiveness when others don’t?
“Dr. Finkelstein said that over time he has come to believe that the ‘return-on-investment’ analysis of weight-loss surgery is ‘misguided.’ This economic metric isn't used to evaluate the cost-effectiveness of treatments for cancer or heart disease.”
3. >>>In the end, whether it is effective at stopping the deadly disease or great reducing its effects on the health of the patient should be the only true cost measured. I am not the only obese person in this company, and it’s not just my life worth being measured here. This company is going to make its feelings shown on how much it values the total health of all of its employees one way or another.
4. >>>One would wonder what the results would be if you took a poll of employees: “We have an employee here with cancer that can be cured but it would mean our rates would go up $25 a year per employee – would you be ok with that…?”
