A major "education" story playing out right now in Buffalo regarding health insurance

[Godhumor]

Cosmetic surgery dearly costs city schools
Usage tripled in six years, going from $1 million to nearly $9 million

"Cosmetic surgery costs for Buffalo Public Schools employees have skyrocketed from less than $1 million in 2004 to nearly $9 million last year.

The vast majority of those procedures — nine out of 10 of them — were chemical peels, laser hair removal, skin rejuvenation and other skin treatments. All of them were elective procedures that required a doctor's approval.

The number of procedures tripled during the same period, with more than 8,000 of them performed for school employees in 2009. Because the district is self-insured for its cosmetic surgery rider, taxpayers cover the entire cost directly, district officials said.

Board of Education member Christopher Jacobs is alarmed by the increase in costs. "On the surface, it smacks of abuse," he said."

http://www.buffalonews.com/city/schools/article233194.ece

To fill in some gaps on this story, the rider has been present in one of the health plans for 30 years. Procedures are supposed to only happen with a doctor's permission, but it looks like a few of the local cosmetic surgery places (8 in total) have an in-house physician approving every person walking through the door. I think the article mentions this but approximately 500 employees account for the majority of the claims. Financial control group is scheduled to present its full findings to the school board next week and is recommending investigating both the surgeons and employees for fraud.

The CFO of Buffalo public schools is saying the $9 million spent this year could have gone to hire more teachers and reduced class sizes. She also maintains the union was asked to give up the rider which refused. The BTF, the local teacher union, president has responded with the union has agreed to give it up in the next signed contract--only problem is, there hasn't been a signed contract in Buffalo since 2004.

This has been news for awhile, but the study was just released and is front page on the newspaper and lead story on all of our news channels (If you google abc buffalo or cbs or nbc it is all right there.).

One of my best friends is married to a 2nd year BPS teacher. In the past 3 weeks he has had a chemical peel, a microdermabrasion, laser hair removal on his back and is 4 sessions through a laser weight reduction program.

It is going to be interesting to see how the board meeting next week plays out.

[MineralMan]

1. Now, there's a benefit that's bound to piss people off.

Cosmetic surgery that isn't done to repair a disfiguring condition should not be covered in normal health insurance. As we see in this case, the cost of beautification surgery raises everyone's costs. Few health insurance policies cover such things.


These days, teachers face increasing skepticism from the public, and stuff like this surely doesn't help. Tone deafness is not a positive thing.

[MadHound]

2. Rather than dropping the rider altogether, they need to change the language

Change it so that plastic surgery can only be approved in cases of accidents, cancer, etc. There are perfectly valid reasons for getting plastic surgery, which is why they need to keep this rider. But I agree, the abuse needs to stop.

[Godhumor]

3. I think that is what the original language of "medically necessary" was meant to convey

Which is why I think the fraud investigation is being recommended.

[Historic NY]

4. How did the laser weight thing work out for him?.....

[Godhumor]

5. One belt loop decrease so far

Says most of the fat around his ribs is now gone. I think he expects to lose another 2 to 3 inches by the time the procedure is finished.

[Historic NY]

8. was that the cold laser or real surgery?

[sinkingfeeling]

6. Elective surgery shouldn't be covered.

[Godhumor]

7. I honestly don't have problems with, say, laser eye surgery being covered

In cases where it would make a dramatic and significant change in people's lives.

I am really curious to see if an official fruad investigation is launched and whether it targets the spas and surgeons or the teachers or both. My assumption is that it will be both.