Insurance reimbursement for the treatment of obesity in children

Objective: Although the prevalence of obesity among children in the United States is rapidly increasing, third party payer reimbursement for evaluatio n and management may be limited. The purpose of this analysis is to evaluat e third party payer reimbursement rates for a pediatric weight management p rogram 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 c enter. Reimbursement rate of charges for initial evaluation and management and patient characteristics were evaluated for children 2 years or older en rolled in the Children's Hospital Weight Management Program. Results: From October 17, 1995, to December 23, 1997, 191 children were eva luated in the Children's Hospital Weight Management Program. The children w ere 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 reimburseme nt rate was 11% and varied widely (0% to 100%). Reimbursement rates differe d significantly among policy types. Reimbursement rates did not differ betw een boys and girls or white and black children, nor were reimbursement rate s associated with the degree of obesity. Conclusions: Despite the need for weight management services for obese chil dren, these low reimbursement rates preclude the long-term financial viabil ity of such programs without external support or a significant proportion o f patients who can pay "out-of-pocket."