North Carolina Blues covers medical visits related to obesity

The insurer hopes outpatient benefits and incentives to bariatric surgeons will trim costs.

By Robert Kazel, AMNews staff. Nov. 1, 2004.

BlueCross BlueShield of North Carolina, which figures it paid an extra $83 million in 2003 because more than half its members are overweight or obese, said in October it plans to start paying doctors to treat obesity on an outpatient basis.

The plan is designating clinics with bariatric surgeons who have more experience and better outcomes as "centers of excellence" to whom the plan will pay significantly more for the controversial and increasingly popular operation.

The decision to authorize reimbursement for obesity-related office visits was good news, doctors said, because while insurers typically reimburse doctors in connection with patients' comorbidities often associated with obesity, such as hypertension or heart disease, payment for evaluation and treatment of obesity itself is virtually unheard of.

"We deal with obesity on a daily basis, and I don't think it's any mystery that obesity is a crisis in America -- and North Carolina is certainly ahead of the curve" in overweight people, said John Mangum, MD, a family physician from Sanford, N.C. It will be especially useful to send patients to dieticians knowing that the visits will be covered, he added.

"Patients often have remarkable misconceptions about diets," he said. "I have patients who drink a two-liter bottle of [soda] every day, and they don't think that's anything unusual."

The Chapel Hill, N.C.-based Blues plan will cover up to four physician office visits annually for obesity starting in April 2005, said Don Bradley, MD, senior medical director. "If we expect physicians to be part of the solution, we should pay for their time," he said.