Weight Loss Treatment and Services

The TAC Medical Excess may apply to these services, except for:

  • Dietitian services
  • Gym, Swimming and Exercising in Rehabilitation Programs, or
  • treatment or services performed in a hospital. 

This policy must be read in conjunction with the Dietitian policyGym and Swimming Memberships policy, Medical Practitioners policyMental Health (psychology) policyPharmacy (Chemist Medications) policy and Surgery (Elective) policy.

Policy

The will consider funding the reasonable cost of weight loss treatment and services where:

  • weight gain is a direct result of injuries sustained in a transport accident, and
  • weight gain is impacting on a client's health, and
  • clinical justification is provided by a registered medical practitioner.

To expedite payment of accounts and ensure the most appropriate services are provided to the client, the TAC encourages prior approval be sought by the requesting medical practitioner.

Transport Accident Act 1986  reference: s.60 and s.23 

DEFINITIONS

In this policy, 'Weight loss treatment and services' refers to treatment and services which are recommended and monitored by a registered medical practitioner and which assist a client to lose weight.

GUIDELINES

Who is eligible eligible for weight loss treatment and services?

The TAC will consider funding the reasonable cost of weight loss and weight management treatment and services where:

  • significant weight gain is as a direct result of injuries sustained in a transport accident and is impacting on a client's health, and
  • a client is unable to independently maintain his/her pre-accident weight due to transport accident injuries, and
  • clinical justification is provided by a registered medical practitioner.

In line with community standards, the TAC expects that a client will independently trial lifestyle interventions, such as diet and exercise to achieve weight loss prior to seeking treatment.

The TAC will be guided by best clinical practice regarding the suitability of individuals for a particular treatment type.

What information does the TAC require in order to consider paying for weight loss treatment or services?

All requests for weight loss treatment or services must be from a registered medical practitioner, and must include the following information:

  • Client's current weight, body mass index (BMI) and waist circumference
  • A history of the client's pre-accident weight, BMI and waist circumference preceding the transport accident
  • Rationale for weight gain being directly related to the client's transport accident injuries
  • Explanation of how the client's excessive weight gain is impacting on his/her general health
  • Details of any lifestyle or dietary factors that may be impacting on the client's ability to independently manage his/her weight
  • Details of any medication or non-accident related conditions that could contribute to the client's weight gain, e.g. thyroid conditions, etc.
  • Clinical justification for any recommended treatment
  • Specific goals of any recommended weight loss treatment or services (i.e. weight loss to attain a specific body weight)
  • Details of how the medical practitioner will review the treatment plan (i.e. how often the patient will be reviewed, what outcome measures will be used, etc.), including expected duration of the review program

Any requests for bariatric surgery must also include the details of lifestyle interventions and/or medication therapies that have been trialled, including length of time of the trial and reasons for the trial failing to achieve weight loss.

The TAC will not consider a request for weight loss treatment or services that does not include the above information.

All requests for weight loss treatment and services will be reviewed by a consultant on the TAC's Clinical Panel.

In relation to weight management and weight loss treatment and services, what will TAC not fund?

The TAC will not fund:

  • medications and surgery where a client is not able to provide evidence that lifestyle interventions have been adequately trialled
  • treatment and services for cosmetic reasons
  • treatment and services where weight is not impacting on a client's health
  • medications where a trial of that type of medication has already been funded
  • weight loss programs or food/meal replacement services, for example home delivered meal services such as Lite 'n easy or commercial weight loss programs such as Weight Watchers, Jenny Craig or Optifast. Refer to the Dietitian policy.
  • treatment, services or equipment where there is no published evidence in a recent peer-reviewed journal article that the treatment, service or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services policy
  • treatment and services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.