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Obesity

Provider Type

  • Physicians (does not apply to Cal MediConnect)
  • Participating Physician Groups (PPG) 
    (does not apply to HSP)
  • Hospitals
  • Ancillary

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

Obesity is defined as an excess of body fat. Body mass index (BMI) is a measure of body weight relative to height. BMI can be used to determine if people are at a healthy weight, overweight or obese. An adult member whose BMI is 25 to 29.9 is considered overweight and a BMI of 30 or more is considered obese. Children with a BMI at the 95th percentile or above are considered obese.

Obesity is a treatable medical condition. Treatment of this condition varies depending on the severity of the members' condition.

Coverage

The primary care physician (PCP) or attending provider may recommend a diet plan for the member to follow and, if medically appropriate, the PCP may refer the member to a dietitian or a provider who specializes in weight-loss management. These services are covered as specialist consultation services. In cases of extreme morbid obesity, other treatments, such as pharmaceutical and surgical services, may be covered.

Health Net does not provide coverage for diet programs, such as Weight Watchers®. Gym memberships and exercise programs are also not covered.

Resources

Health Net's Medi-Cal and Cal MediConnect members are eligible to receive weight control resources and services through the Health Net Health Education Department. Resources and services include:

  • Fit Families for Life program - Mailed educational program with nutrition tips, exercise band and cookbook to help families and children eat healthy and stay active
  • Healthy Habits for Healthy People Program - Nutrition and physical activity resource for older adults. Includes a workbook, cookbook and exercise band.

Providers may refer members interested in these resources via the Fit Families for Life-Be In Charge! Referral form (Health Net (PDF) or CalViva Health (PDF). Contact the Health Education Department, Cal MediConnect Los Angeles, Cal MediConnect San Diego for more information.

The following information does not apply to Medi-Cal

All participating physician groups (PPGs) or attending providers offer patient education programs, including weight management. For more information regarding Health Net's weight loss interactive tools, discounts and online education programs for commercial plans, refer members to the Decision Power® program, Wellness Programs or Healthy Discounts section on Health Net's website.

  • For all provider portal needs applicable to Individual Family Plan (IFP) members, refer to the new provider website.
  • For all provider portal needs applicable to employer group HMO, PPO, and EPO; POS, and Cal MediConnect members, refer to the current provider website.
Last Updated: 08/05/2021