Navigating the ins and outs of what is covered and what is not is frustrating on a good day and raises the blood pressure of the very people insurance is meant to help on a bad one.
However, many U.S. adults rely on insurance to cover the treatment and diagnosis of what ails them.
A new survey conducted for the Wall Street Journal Online's Health Industry Edition has taken insurance coverage a step further by asking people questions about the coverage of "quality of life" treatments such as birth control, in vitro fertilization, cosmetic procedures and drugs like Viagra to treat erectile or other sexual dysfunction.
Dr. William Kirby with Sutter Health in Auburn is an urologist and treats men with impotence.
In many instances when he prescribes drugs like Viagra, Cialis or Levitra, Kirby said the prescription is based on medical needs and that the end result also improves the "quality of life" for his patients.
"It has been researched that people with better sex lives are healthier," he said. "And for that reason, treating this is important. These drugs have become the number one recreational drug on the market today."
Kirby said that for many of his patients, the sexual dysfunction prescriptions are indeed covered by insurance.
Still, in the cases where insurance won't cover the cost of a prescription, he believes his patient's quality of life is compromised.
"Some people that need it, won't get it if they can't afford the prescription. That is basic," he said.
In the survey, 50 percent of adults indicated that they think standard insurance plans should cover drugs to treat erectile dysfunction along with 81 percent saying they thought birth control treatments should be covered. Sixty-three percent were in favor of in vitro fertilization coverage. Of those surveyed, two-thirds thought insurance should cover drugs that improve memory (65 percent), while three in five supported coverage for weight-loss drugs.
Support for coverage diminished, however, for treatments that primarily impact people's personal appearance, such as drugs to reduce the appearance of wrinkles, plastic surgery to help people look younger and growth hormones to help children grow taller.
Auburn dermatologist and cosmetic surgeon Timothy J. Rosio, M.D., said that he uses Botox and lasers for medical corrective treatments as well as cosmetic treatments that improve self esteem.
"In my opinion, 'wellness' is not just the absence of disease, rather it is the presence of health and healthy self-esteem," he said.
Rosio said it is at the discretion of the insurance companies to decide what treatments will be "covered."
He said it takes three full-time staffers to navigate the billing portion of his practice in today's complex insurance billing industry.
"Most people don't know what their insurance covers," he said. "The insurance companies can exclude anything they want."
All the same, people who make appointments at Rosio's office for treatments, such as Botox injections to treat frown lines and crow's feet, plan to pay out of pocket for the treatment that starts at $350 and averages $650.
The American Society for Aesthetic Plastic Surgery reports that Botox treatment is the number one non-surgical treatment and that more than 3.1 million Botox procedures were performed in 2005, up 16 percent from 2004. And even with this boom, survey results continue to indicate that people are in favor of paying out of pocket for such aesthetic treatments with only 13 percent indicating that Botox treatments should be covered.
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