Table 3: Lessons learned from expansion of health insurance coverage.

Key processesFindings

Claims processing(i) Challenging to integrate BMI information with claims processing
(ii) Insurer-specific billing codes are challenging for providers who bill to multiple insurers

Benefit structure(i) Most offered more generous coverage than required by the initiative
(ii) Most but not all allow direct billing by registered dietitians
(iii) Copayments varied and were often significant

Coordination with other wellness programs Programs often not coordinated

Enrollment requirements(i) Pre-certification and disease management enrollment requirements created barriers to utilization
(ii) Manual enrollment processes created barriers to provider participation

Marketing(i) Insurers tend to focus outreach on providers
(ii) Employers tend to focus outreach on employees

Engaging providers(i) Difficult to know if materials ever reach the provider
(ii) Direct interaction with providers is the most successful
(iii) Insufficient number of registered dietitians available in some networks
(iv) Providers have educational needs around motivational interviewing, billing codes, and effective care coordination between physician practices, dietitians, and health educators

Engaging families(i) Most marketing efforts focused on open enrollment period
(ii) Need for coordination between employers and insurers to effectively identify and reach overweight children

Monitoring utilization of obesity-related health services(i) Infrequent use of BMI-specific billing codes
(ii) Infrequent use of counseling-specific billing codes

BMI: body mass index.