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What should health care plans pay for?


Monday, July 23, 2012

What should health care plans pay for?

There has to be some parity in health care plan expenditures among people who maintain general health and those need medical care. Those of us lucky enough to maintain general health pay more with less return than those of us who need medical treatment. It does rankle a bit, especially when maintaining a healthy weight is involved.

I was morbidly obese for years. I suspect had I documented efforts to lose weight and been unsuccessful I could have been a candidate for medical intervention, surgery or nutrition plans. I certainly had some co-morbidities for obesity including joint pain and creeping high blood pressure.

None of the options I exercised for reducing my mass are covered by my health care plan except for when I got injured in 2011, nor are they covered in an IRS-approved flexible heath care spending plan. I paid for these things out-of-pocket after taxes: gym membership, bicycles, running shoes, skis, nutritious food (instead of prescribed weight loss meals). And these things have contributed to my mental and physical health.

However, had I been taking care of my general health all along I wouldn't have been morbidly obese. Therefore wellness - how to encourage, reward, and mitigate costs of wellness without being a huge draw on the insurance accounts when a medical problem occurs - is a good goal.

What started this line of thought is a discussion on whether or not I should seek a prescription for a massage from my physician. As it stands, I can only get my health care plan to pay for massage as it relates to a medical condition. I could get a referral to a chiropractor or physical therapist to make a plan to treat injury or pain. I am not injured or in pain right now.

Massage for my general wellness would be nice. Should insurance pay for it when I do not have a medical condition except being active and alive? Well... no.

I suppose it would be different if massage really worked as a de-stressor for me. It turns out cognitive therapy has been a better way for me to manage chronic stress and emotions than massage. It costs a little more, and is covered by my employee assistance program (with co-pay) but for me has a lot of benefits.

In a way, it is parity, isn't it? I am incurring mental health care costs to keep my physical health care costs in check. For me, my mind comes before my body. My body will follow where my mind leads. The cognitive therapy has helped my mind listen to my body, and my body followed by being active and healthy.

I also think there is parity in the costs in the money I save and the costs I don't incur. I have more money in my pocket because I have fewer and lower co-payments. There are the costs that can't be quantified as I pursue a happy, healthful lifestyle with good relationships.
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Member Comments About This Blog Post:
CKMATHERLY 7/23/2012 4:36PM

    Sorry, mine health care doesn't even cover routine labs till I reach my $7500 deductable. So I know a massage is out of the question!

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