Insurance reimbursement for the treatment of obesity in children

• Published in: The Journal of pediatrics Vol. 134; no. 5; pp. 573 - 578
• Main Authors: Tershakovec, Andrew M., Watson, Miriam H., Wenner, William J., Marx, Alison L.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.1999; Elsevier; Mosby-Year Book, Inc
• Subjects: African Americans - statistics & numerical data; Biological and medical sciences; Child; Child Health Services - economics; Child, Preschool; Cross-Sectional Studies; European Continental Ancestry Group - statistics & numerical data; Female; General aspects; Health systems. Social services; Humans; Insurance, Health, Reimbursement; Male; Medical sciences; Obesity - economics; Obesity - therapy; Public health. Hygiene; Public health. Hygiene-occupational medicine; United States; United States; North America; America; ht z-score; WMP; wt z-score; BMI; Human; Health insurance; Obesity; Ethnic origin; Managed care; Nutrition disorder; Sex; Negroid; Body mass index; Treatment; Welfare aids; Caucasoid; Contract; Child; Age; Nutritional status; Comparative study
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(99)70243-X

Objective: Although the prevalence of obesity among children in the United States is rapidly increasing, third party payer reimbursement for evaluation and management may be limited. The purpose of this analysis is to evaluate third party payer reimbursement rates for a pediatric weight management program for obese children and associations among child characteristics (eg, degree of obesity), insurance policy type, and reimbursement rates. Study design: Cross-sectional survey in a tertiary care pediatric medical center. Reimbursement rate of charges for initial evaluation and management and patient characteristics were evaluated for children 2 years or older enrolled in the Children’s Hospital Weight Management Program. Results: From October 17, 1995, to December 23, 1997, 191 children were evaluated in the Children’s Hospital Weight Management Program. The children were on average 10.1 ± 0.3 years old, with a mean body mass index z-score of 4.9 ± 0.2; 46% were black, and 65% were female. The median reimbursement rate was 11% and varied widely (0% to 100%). Reimbursement rates differed significantly among policy types. Reimbursement rates did not differ between boys and girls or white and black children, nor were reimbursement rates associated with the degree of obesity. Conclusions: Despite the need for weight management services for obese children, these low reimbursement rates preclude the long-term financial viability of such programs without external support or a significant proportion of patients who can pay “out-of-pocket.” (J Pediatr 1999;134:573-8)