Obesity & Weight Management Benefit

Louisiana Blue has partnered with the Alliance for a Healthier Generation* to increase awareness about a benefit for children who are diagnosed as overweight or obese.

For low-risk patients:

• Who: Children ages 3 to 18 who are diagnosed as overweight or obese and covered under a non-grandfathered policy.
• What: Four primary care physician visits and four registered dietitian (RD) visits as contract benefits. If the child is under a grandfathered, fully insured policy*, registered dietitian visits are covered as contract benefits and the member’s co-insurance, copayment and deductible applies.

For high-risk patients:

• Who: Children ages 3 to 18 diagnosed with obesity.
• What: 52 visits of intensive treatment with eligible health and behavior programs and professionals. The 52 visits with an in-network provider begin when the child is diagnosed with obesity at his or her annual visit. After the 52 visits, coverage moves to contract benefits. The coverage is a once-in-a-lifetime benefit.
• Note: These members should be referred to local, in-network health and behavior intervention specialists, including RDs, psychologists (Ph.D.) and licensed professional counselors (LPC).

Please tell your patients with Louisiana Blue coverage that children diagnosed as obese may be eligible for more help. Louisiana Blue customers can contact the toll-free Customer Service phone number on their ID cards for details on what is covered under their plans.

Alliance for a Healthier Generation:

• Other Resources -  include videos, printables, websites, and curricula

American Academy of Pediatrics:

• Pediatric ePractice (PeP) Optimizing your Obesity Care (must have account)
• Patient Education Fact Sheets
• Patient/Family Screeners
• Clinical Support Tools
• Policy and Guidelines
• CME and MOC opportunities
• Books and Resource Materials
• Billing and Practice Management Resources
• Staff Training and Wellness
• Community Advocacy

• Healthy Active Living for Families (HALF) Provider Resources
• Recommendations by age
• Interactive Tools
• Techniques for communicating with families
  
  
• Providers Guide and Flip-Charts
• (Next Steps) in the AAP Bookstore

• General AAP Resources
• AAP Institute for Healthy Childhood Weight

Academy of Nutrition and Dietetics

• Evidence Based Nutrition Practice Recommendations for Registered Dietitian Nutritionists

• The Pediatric Weight Management Evidence Analysis Library Project

• Kids Eat Right
• Articles
• Tip sheets
• Videos
• Recipes

• Eat Right Pro

• Academy Store
• Pediatric Nutrition Care Manual
• Pediatric Weight Management Toolkit
• The Complete Counseling Kit for Pediatric Weight Management
• Academy of Nutrition and Dietetics Pocket Guide to Children with Special Health Care and Nutritional Needs
• All Pediatric Nutrition products

Adults ages 19 and older, diagnosed by their primary care doctor as obese and covered under an eligible policy*, can get 12 visits per benefit period with their PCP, as well as 12 counseling visits with an in-network registered dietitians (RD) and behavioral health professionals.

Does your member want to prevent a weight problem before it starts? We cover one registered dietitian visit each year for adults 19 and older with no out-of-pocket cost, regardless of diagnosis.

This guide outlines general billing for Childhood and Adult obesity benefits. It is not a guarantee of benefits. Use iLinkBlue to verify member benefits prior to rendering services. Please share this guide with those who bill claims for your organization.

*Non-grandfathered, ACA-compliant policy. Members should call the customer service phone number on their ID card to determine if their policy is eligible. For adults, the weight treatment benefit is new for 2019 and coverage starts when their plan renews, which may be later in 2019.