November 27, 2004

N.Y. Creates Site on Obesity, Insurance

ALBANY, N.Y. - The state of New York is responding to complaints from citizens about the complexity of health insurance coverage for obesity treatment by releasing an online consumer guide.

"Focus On: Overcoming Obesity" will be available online ( through the state Attorney General's Office starting Sunday. The site was created in response to complaints and concerns from consumers to the office.

Many consumers simply give up trying to navigate the forms and restrictions even if their health plan covers obesity treatment from counseling and drugs to gastric bypass surgery, said Attorney General Eliot Spitzer.

"Health insurance plans often create obstacles to proper treatment," Spitzer said. "The goal of this report is to help people overcome these obstacles and get the treatment they need to help avoid serious long-term health problems linked to obesity."

Most health insurance plans still don't cover obesity or consider it a disease, although one in six Americans is considered obese and most health plans address related diseases including diabetes, said Joe Baker, Spitzer's health care bureau chief.

"What we're seeing is consumers coming to us with a need for obesity treatment and not getting coverage," Baker said Friday. "Even plans that agree obesity is a disease have preconditions that sometimes are unreasonable or arbitrarily imposed on some individuals."

Some tips from the report:

-Contact an insurance plan early in the process of seeking obesity treatment to find out what kind of clinical assessments are needed.

-Keep detailed medical records.

-File an appeal any time coverage is initially denied.

The report relates complaints to the Attorney General's Office, without naming the patients. The stories include a woman who faced denial because the health plan changed its lengthy preconditions while she sought care, and another who appealed initial denials that the treatment wasn't medically necessary.