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27 States Deny Obesity Treatment – Complaint Filed

November 2015 - The American Society for Metabolic and Bariatric Surgery (ASMBS) and groups including The Obesity Society (TOS) and Academy for Nutrition and Dietetics (AND), filed a complaint with U.S. Health and Human Services (HHS) claiming the 27 states that deny coverage for bariatric surgery are in non-compliance with the Affordable Care Act (ACA) and that their failure to comply is discriminatory against women and people with disabilities, and violates the ban against denying coverage based on health status or a pre-existing condition.

The ASMBS, TOS, and AND are joined in the complaint by the Obesity Medicine Association (OMA) and the Obesity Action Coalition (OAC), a patient advocacy group with more than 50,000 members. All five groups belong to the Obesity Care Continuum.

"Qualified health plans should not be able to discriminate against people with the disease of obesity and unfortunately this is happening in most states,” said John M. Morton, MD, MPH, President of the ASMBS and Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine. “The time has come for equitable treatment for the millions of patients affected by obesity. There needs to be one America where treatment for obesity is an option for everyone.”

Dr. Morton noted that treatment for chronic diseases other than obesity are routinely covered. Obesity was classified as a disease by the American Medical Association in 2013.

“There’s a double standard when it comes to obesity,” Dr. Morton added. “Most insurers are covering the treatments for the complications and consequences of obesity, but are not covering the treatment of obesity itself.”

In the complaint, the groups say there is a significant disparity between the 27 ACA benchmark plans that deny or exclude coverage for bariatric surgery, and the major private and government health insurance plans that provide coverage. Medicare, 49 state Medicaid plans, the Federal Employees Health Plan, the majority of state health plans, and the majority of employer-based plans with 500 employees or more cover bariatric surgery.

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