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Essential Health Benefits

Before and After BMI

May 31, 2013

Essential Health Benefits

As part of the new affordable health care act the state has come up with a list of things that insurance for state employees will and will not cover. These are known as essential health benefits or EHBs. In Texas, at the present time, bariatric services are not among the EHBs. This is perplexing given that the federal government via the Center for Medicare Services (CMS) has validated both surgical and medical weight management as critical tools in physician’s armamentarium in the fight against obesity.

For years we have known that successful treatment of obesity has real and measurable effects on the cost of healthcare by reducing or eliminating adiposity related illness. In the case of diabetes, this can save the system over $10,000 per patient every year in treatment costs. As we all know many patients have several adiposity related conditions and are at risk for serious life threatening ones such as coronary artery disease and cancer.  Fortunately these risks to the patients and the costs to the healthcare system can be minimized by simply providing all with a comprehensive treatment program.

It would appear that in Texas, our state government has yet to come to this conclusion. Instead the way the EHBs in our state were selected was to model it on the most popular Blue Cross and Blue Shield carried here. Please take a moment to reach out to your state representative and let them know Bariatric treatment, both surgical and medical need to be a part of the EHBs in Texas.

Follow the link to find your state representative. Once you click to their page there is a button to email them under their photo. After you do it, will you email me so I can keep a count?

Michael Seger, M.D.

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