Metabolic measurements could play a role in health care reimbursement in the future.
Weight loss programs often help health club members slim down, make lifestyle changes and improve their health. When members try to get reimbursed for these programs by their health insurance companies, however, they often find they have to reach into their own pockets to cover the expenses.
Although Medicare now recognizes obesity as an illness, the government health insurance program doesn't cover any weight loss programs, health care memberships, metabolic testing or weight loss drugs — only weight loss surgery to prevent death due to obesity, says Don McLeod, a spokesperson for the Centers for Medicare and Medicaid.
When it comes to private insurance companies, the policies for reimbursement vary across the board. Blue Cross and Blue Shield, for example, has 38 independently owned and operated plans, so there isn't one universal coverage decision for these plans, says Jackie Fishman of Blue Cross and Blue Shield.
Weight loss programs at health clubs are rarely reimbursable unless they have medical supervision, says Casey Conrad, president of Healthy Inspirations, a national chain of weight loss centers. AETNA insurance coverage is no exception. In most AETNA plans, weight reduction programs are excluded from reimbursement unless they're administered by a physician or an AETNA-contracted facility, says Susan Millerick, an AETNA spokesperson. The insurance carrier provides discounts for memberships to 1,500 gyms nationwide. AETNA also offers discounts for Weight Watchers and Jenny Craig, but not for weight loss programs inside health clubs.
Health club owners and weight loss program managers have been facing a battle to get their programs reimbursed for a long time.
“It's difficult for some insurance companies to give reimbursements on health care memberships, never mind weight loss programs,” Conrad says. “The irony is that many insurance companies pay for gastric bypass, and there are lots of people who could have prevented that.”
Ronda Gates, president of Lifestyles by Ronda Gates, has tried for the last 24 years to convince insurance companies to take a more active role in preventive medicine to cut health care costs. “There's been a shift in the government's approach to dealing with obesity, but it's much slower than I had hoped,” she says.
Know Your Role
Like weight loss programs, metabolic testing is often not reimbursable by insurance companies. Robert Karch, professor at American University, says these tests could help with insurance reimbursement of weight loss programs in the future.
“Certain insurance companies are becoming proactive about supporting programs that have to do with sound, safe weight management,” he says.
One manufacturer is trying to demonstrate a valid reason for insurance companies to reduce premiums or provide other incentives to clients using metabolically based diet and exercise programs. The company has studies underway at medical centers to prove to insurance plans that clients with programs based on objective assessments will get better results than those using estimates. The manufacturer is now specifically targeting the health club market.
“We're at the tipping point where we hope some decisions will be made based on the information we are providing,” says Jerry Krier from the metabolic testing company. “As far as we can tell, things are progressing well. We're striving to demonstrate to the insurance companies that they'll profit by lowering their insurance costs.”
With insurance reimbursement for metabolic testing still on the horizon, some health clubs are working directly with doctors to make inroads into the medical community. Other fitness facilities have doctors on staff to supervise their weight loss programs.
Dr. Mark Dedomenico founded the 20/20 LifeStyles weight loss program at the PRO Sports Club in Bellevue, WA, in 1993. Five doctors, 13 dieticians, nine counselors, and 90 exercise physiologists and personal trainers run the program, which costs each participant an average of about $6,110-$10,290 for 22 weeks-32 weeks. Not all participants pay for the program out of pocket. If they have the right employer, at least part of the cost may be covered. For example, Microsoft subsidizes about 80 percent of the cost of the program for its employees and their spouses. With the Microsoft corporate campus across the street from the club, about 95 percent of her clients are from Microsoft, says Kristen Reaves, a registered dietician.
Metabolic testing plays a role in the program by giving information to the dieticians and personal trainers so they can set goals for their clients and monitor their progress. The club offers VO2 testing, resting metabolic rate testing, underwater weighing and body fat testing.
“Our weight loss program is intense, so we try to have all the high-tech devices to give our clients the most accurate results we can,” Reaves says.
At Sky Fitness and Wellbeing in Tulsa, OK, members' metabolic tests are reimbursed if they are specifically prescribed by a doctor. One of Sky's members is reimbursed for personal training sessions and metabolic testing because his doctor prescribed the exercise, testing and training regimen after his involvement in a car accident, says David Haley, fitness services director at Sky. A few other members also have had their testing costs reimbursed, Haley says.
Sky, a 47,000-square-foot club with a physical therapy clinic, opened in March and now has 2,500 members with 20 clients enrolled in its new 12-week weight loss program called Sky 180. The club charges $85 to test members' resting metabolic rate and $110 for a VO2 max test. The dieticians and personal trainers use the information from the metabolic tests to design a customized nutrition and exercise program for each client.
“Metabolic testing is a sound basis and foundation for developing a good program,” Haley says. “Over time, the more specific you can get about your nutritional program, the better outcome you will have for the results you are looking for.”
For the YMCA of greater St. Paul and metropolitan Minneapolis, metabolic testing has provided an additional source of revenue, added value to the Y's personal training services and helped clients to achieve better results, says Michael Iserman, director of personal training for the YMCA of greater St. Paul and metropolitan Minneapolis. Seven of the 21 branches have purchased the system, and other branches are considering investing in metabolic testing.
“The testing allows them to take a more scientific approach to an exercise program,” he says. “It's not a one-time assessment but an ongoing process that helps to move them toward their goals.”
With Americans' waistlines expanding by the minute, fitness facilities are now offering metabolic testing as part of their weight loss and personal training programs. As of now, however, many health club members are still responsible for covering the cost of this testing. Fitness professionals like Iserman hope that will change in the future.
“I think like personal training, metabolic testing will be an out-of-pocket expense until the health care organizations see the benefits of prevention versus treatment,” he says.
Testing and Measuring Equipment
Check out some of the following companies' Web sites for more information about these products and services.
- American Weights and Measures: www.americanweightsandmeasures.com
- Apex Fitness Group: www.bodybugg.com
- Biodynamics Corp.: www.biodyncorp.com
- Biosig Instruments: www.biosiginstruments.com
- BodyMedia Inc.: www.bodymedia.com
- Creative Health Products Inc.: www.chponline.com
- Futrex Inc./Zelcore: www.zelcore.com
- KORR: www.thefitnessexpert.com
- Life Measurement Inc.: www.thebodpod.com
- New Leaf Health and Fitness Products: www.newleaffitness.com
- Novel Products Inc.: www.novelproductsinc.com
- Omron Healthcare Inc.: www.omronhealthcare.com
- POLAR USA: www.polarusa.com
- Tanita Corp.: www.tanita.com