The AAP changes its stance on circumcision

mben1119 · August 2012

https://www.tabletmag.com/scroll/110165/leading-pediatric-group-endorses-circumcision

smilelari · August 2012

I've heard that they were going to change their stance, however, reading this, I'm not sure what's changed? The article says that the benefits aren't great enough to recommend this as a routine procedure but that parents should be allowed access and that payment by insurance should be allowed. Sounds like the same old, same old to me

mben1119 · August 2012

smilelari:

I've heard that they were going to change their stance, however, reading this, I'm not sure what's changed? The article says that the benefits aren't great enough to recommend this as a routine procedure but that parents should be allowed access and that payment by insurance should be allowed. Sounds like the same old, same old to me

Many insurance companies don't cover circumcisions anymore, so their changed stance could help people who would want to get the procedure pay for it.

smilelari · August 2012

mabenner1:
smilelari:

I've heard that they were going to change their stance, however, reading this, I'm not sure what's changed? The article says that the benefits aren't great enough to recommend this as a routine procedure but that parents should be allowed access and that payment by insurance should be allowed. Sounds like the same old, same old to me

Many insurance companies don't cover circumcisions anymore, so their changed stance could help people who would want to get the procedure pay for it.

Honestly, I think it's kind of inappropriate for the AAP to make statements about what insurance should/should not cover. These medical orgs should make strictly medical statements, like "this procedure isn't recommended as a routine procedure" and the insurance companies should make their decisions based on that medically based statement.

mben1119 · August 2012

smilelari:
mabenner1:
smilelari:

I've heard that they were going to change their stance, however, reading this, I'm not sure what's changed? The article says that the benefits aren't great enough to recommend this as a routine procedure but that parents should be allowed access and that payment by insurance should be allowed. Sounds like the same old, same old to me

Many insurance companies don't cover circumcisions anymore, so their changed stance could help people who would want to get the procedure pay for it.

Honestly, I think it's kind of inappropriate for the AAP to make statements about what insurance should/should not cover. These medical orgs should make strictly medical statements, like "this procedure isn't recommended as a routine procedure" and the insurance companies should make their decisions based on that medically based statement.

But then who should get to recommend things to the insurance companies? If they had it their way, they'd cover absolutely nothing.

smilelari · August 2012

mabenner1:
smilelari:
mabenner1:
smilelari:

I've heard that they were going to change their stance, however, reading this, I'm not sure what's changed? The article says that the benefits aren't great enough to recommend this as a routine procedure but that parents should be allowed access and that payment by insurance should be allowed. Sounds like the same old, same old to me

Many insurance companies don't cover circumcisions anymore, so their changed stance could help people who would want to get the procedure pay for it.

Honestly, I think it's kind of inappropriate for the AAP to make statements about what insurance should/should not cover. These medical orgs should make strictly medical statements, like "this procedure isn't recommended as a routine procedure" and the insurance companies should make their decisions based on that medically based statement.

But then who should get to recommend things to the insurance companies? If they had it their way, they'd cover absolutely nothing.

The insurance company should recommend things to the insurance company and if the coverage is inadequate the consumer should take their money elsewhere.

Just because the AAP recommends it, doesn't mean that they'll cover it and the AAP doesn't generally include a statement about insurance coverage in their statements (as far as I know), so this inclusion is a departure from the norm. So, the insurance company can go ahead and have their way and not cover it if that's what they choose.

mben1119 · August 2012

smilelari:
mabenner1:
smilelari:
mabenner1:
smilelari:

I've heard that they were going to change their stance, however, reading this, I'm not sure what's changed? The article says that the benefits aren't great enough to recommend this as a routine procedure but that parents should be allowed access and that payment by insurance should be allowed. Sounds like the same old, same old to me

Many insurance companies don't cover circumcisions anymore, so their changed stance could help people who would want to get the procedure pay for it.

Honestly, I think it's kind of inappropriate for the AAP to make statements about what insurance should/should not cover. These medical orgs should make strictly medical statements, like "this procedure isn't recommended as a routine procedure" and the insurance companies should make their decisions based on that medically based statement.

But then who should get to recommend things to the insurance companies? If they had it their way, they'd cover absolutely nothing.

The insurance company should recommend things to the insurance company and if the coverage is inadequate the consumer should take their money elsewhere.

Just because the AAP recommends it, doesn't mean that they'll cover it and the AAP doesn't generally include a statement about insurance coverage in their statements (as far as I know), so this inclusion is a departure from the norm. So, the insurance company can go ahead and have their way and not cover it if that's what they choose.

I think most insurance companies follow recommendations from medical organizations, though. I'm not positive on that, and I don't know how I even feel about it.

Mom2Cinderella · August 2012

I work for the insurance department-but not health/life insurance. I can tell you that the types of exclusions/restrictions that these insurance companies come in with is RIDICULOUS. Insurance companies are not like a public company like Target or Babies R Us. They are regulated by each state's government. They have to adhere to state regulations and any time they want to make a change to their policy, whether it's coverage increase or decrease or financial, they have to submit an official filing with the state government to be approved. So these companies can't just run on capitalism. And if everyone remembers, a few years back it was stated that women did not need mammograms until age 50. Insurance companies wanted to jump on that and not cover them until age 50. Insurance companies try to eliminate coverage for the pill. The list can go on.

As a side note, there are religious groups who circumcise. There are people who will continue to want their sons circumcised. It isn't fair to let the insurance company decide who can have the procedure done. In that case, only those who are well off would be able to have such a medical procedure done. Those who can't afford it would not be able to have it done, even if it goes against their religious or ethical beliefs.

smilelari · August 2012

Mom2Cinderella:
I work for the insurance department-but not health/life insurance. I can tell you that the types of exclusions/restrictions that these insurance companies come in with is RIDICULOUS. Insurance companies are not like a public company like Target or Babies R Us. They are regulated by each state's government. They have to adhere to state regulations and any time they want to make a change to their policy, whether it's coverage increase or decrease or financial, they have to submit an official filing with the state government to be approved. So these companies can't just run on capitalism. And if everyone remembers, a few years back it was stated that women did not need mammograms until age 50. Insurance companies wanted to jump on that and not cover them until age 50. Insurance companies try to eliminate coverage for the pill. The list can go on.
As a side note, there are religious groups who circumcise. There are people who will continue to want their sons circumcised. It isn't fair to let the insurance company decide who can have the procedure done. In that case, only those who are well off would be able to have such a medical procedure done. Those who can't afford it would not be able to have it done, even if it goes against their religious or ethical beliefs.

A couple thoughts on all of this. I don't think insurance companies should have to cover the pill. I also think it's dumb of them not to because pregnancy, childbirth and then child healthcare is way more expensive to cover than the pill is. I do think that insurance should cover medically warranted mammograms, but then again, it's dumb not to considering the costs for covering cancer treatments.

I don't think that insurance companies should have to cover something because some religions demand it. They cover medical procedures, not religious ones.

Mom2Cinderella · August 2012

And am I reading a different article? I read that the AAP stated that the benefits outweigh the risks and that they endorse the procedure...

smilelari · August 2012

Mom2Cinderella:
And am I reading a different article? I read that the AAP stated that the benefits outweigh the risks and that they endorse the procedure...

The next to the last paragraph states:

Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Mom2Cinderella · August 2012

smilelari:
Mom2Cinderella:
I work for the insurance department-but not health/life insurance. I can tell you that the types of exclusions/restrictions that these insurance companies come in with is RIDICULOUS. Insurance companies are not like a public company like Target or Babies R Us. They are regulated by each state's government. They have to adhere to state regulations and any time they want to make a change to their policy, whether it's coverage increase or decrease or financial, they have to submit an official filing with the state government to be approved. So these companies can't just run on capitalism. And if everyone remembers, a few years back it was stated that women did not need mammograms until age 50. Insurance companies wanted to jump on that and not cover them until age 50. Insurance companies try to eliminate coverage for the pill. The list can go on.
As a side note, there are religious groups who circumcise. There are people who will continue to want their sons circumcised. It isn't fair to let the insurance company decide who can have the procedure done. In that case, only those who are well off would be able to have such a medical procedure done. Those who can't afford it would not be able to have it done, even if it goes against their religious or ethical beliefs.

A couple thoughts on all of this. I don't think insurance companies should have to cover the pill. I also think it's dumb of them not to because pregnancy, childbirth and then child healthcare is way more expensive to cover than the pill is. I do think that insurance should cover medically warranted mammograms, but then again, it's dumb not to considering the costs for covering cancer treatments.
I don't think that insurance companies should have to cover something because some religions demand it. They cover medical procedures, not religious ones.

Exactly- the pill is cheaper than the medical coverage in its absence. Which is the state's reasoning behind saying no to some of the insurance companies' proposals. A lot of this boils down to public health and what is best for the masses. Imagine the uproar that any change like this would cause. The state government's job is to watch out for consumers and to find a balance so the company can be profitable but the consumers also are "happy".

Remember-companies like banks and insurance companies have to pay for a license to do business in the state. Ultimately to make a profit. If they don't want to adhere to the state governements' regulations, they can leave the state and do business elsewhere. But then you as a consumer have less competition and less to choose from as far as insurance. Ultimately, the cost goes up if the market is so narrow.

The state government takes recommendations from organizations such as WHO and AAP to decide what to let companies do or how much to charge. Your state representatives don't know the statistics, etc behind circumcisions-they are lawyers not doctors or scientists. They look to recommendations from medical professionals and scientists to decide whether insurance companies should exclude such coverage or not.

Mom2Cinderella · August 2012

smilelari:
Mom2Cinderella:
And am I reading a different article? I read that the AAP stated that the benefits outweigh the risks and that they endorse the procedure...
The next to the last paragraph states:
Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Oh-I didn't see that part. I take that to mean though that it shouldn't be pushed on those who choose not to do it. Like vaccination they push against people who decline them. But this, I think they are saying, there isn't necessarily harm in opting out.

smilelari · August 2012

Mom2Cinderella:
smilelari:
Mom2Cinderella:
I work for the insurance department-but not health/life insurance. I can tell you that the types of exclusions/restrictions that these insurance companies come in with is RIDICULOUS. Insurance companies are not like a public company like Target or Babies R Us. They are regulated by each state's government. They have to adhere to state regulations and any time they want to make a change to their policy, whether it's coverage increase or decrease or financial, they have to submit an official filing with the state government to be approved. So these companies can't just run on capitalism. And if everyone remembers, a few years back it was stated that women did not need mammograms until age 50. Insurance companies wanted to jump on that and not cover them until age 50. Insurance companies try to eliminate coverage for the pill. The list can go on.
As a side note, there are religious groups who circumcise. There are people who will continue to want their sons circumcised. It isn't fair to let the insurance company decide who can have the procedure done. In that case, only those who are well off would be able to have such a medical procedure done. Those who can't afford it would not be able to have it done, even if it goes against their religious or ethical beliefs.

A couple thoughts on all of this. I don't think insurance companies should have to cover the pill. I also think it's dumb of them not to because pregnancy, childbirth and then child healthcare is way more expensive to cover than the pill is. I do think that insurance should cover medically warranted mammograms, but then again, it's dumb not to considering the costs for covering cancer treatments.
I don't think that insurance companies should have to cover something because some religions demand it. They cover medical procedures, not religious ones.
Exactly- the pill is cheaper than the medical coverage in its absence. Which is the state's reasoning behind saying no to some of the insurance companies' proposals. A lot of this boils down to public health and what is best for the masses. Imagine the uproar that any change like this would cause. The state government's job is to watch out for consumers and to find a balance so the company can be profitable but the consumers also are "happy".
Remember-companies like banks and insurance companies have to pay for a license to do business in the state. Ultimately to make a profit. If they don't want to adhere to the state governements' regulations, they can leave the state and do business elsewhere. But then you as a consumer have less competition and less to choose from as far as insurance. Ultimately, the cost goes up if the market is so narrow.
The state government takes recommendations from organizations such as WHO and AAP to decide what to let companies do or how much to charge. Your state representatives don't know the statistics, etc behind circumcisions-they are lawyers not doctors or scientists. They look to recommendations from medical professionals and scientists to decide whether insurance companies should exclude such coverage or not.

See, and I think that insurance companies can make a decision on what to cover just based on the medical recommendation in the policy statement from the AAP or ACOG or whatever. So, the AAP just says they don't recommend routine circumcision... the benefits outweigh the risks... (and they said both, so they just basically said nothing, LOL) and the insurance company runs with just that. The AAP has no business telling the insurance company what they should do with that information, they just give the information.

Mom2Cinderella · August 2012

Well the insurance company can propose to not cover circumcisions because they dont' want to and think it's not medically necessary, etc. But then they have to submit their proposal to the state government, who is then going to review it and say "Ok you can exclude it" or "No way. The AAP endorses this procedure and there are too many residents of this state that expect coverage for this". Or the government might say "No way we just gave you a rate increase of 10%. We aren't allowing you to provide less coverage". It all depends. But the bottom line is the company doesn't get to just decide what it's going to do. It's not just an open capitalistic business.

smilelari · August 2012

Mom2Cinderella:
smilelari:
Mom2Cinderella:
And am I reading a different article? I read that the AAP stated that the benefits outweigh the risks and that they endorse the procedure...
The next to the last paragraph states:
Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.
Oh-I didn't see that part. I take that to mean though that it shouldn't be pushed on those who choose not to do it. Like vaccination they push against people who decline them. But this, I think they are saying, there isn't necessarily harm in opting out.

And I take the part about "warrant third-party payment" to mean that it's ok for insurance companies to pay for it if they feel like it. And I'm going to guess that most insurance companies that feel like paying for circumcision already do

Mom2Cinderella · August 2012

Estwd2:
Mom2Cinderella:
And am I reading a different article? I read that the AAP stated that the benefits outweigh the risks and that they endorse the procedure...
Are you thinking of this study?
https://articles.baltimoresun.com/2012-08-20/health/bs-hs-circumcision-economics-study-20120820_1_male-circumcision-circumcision-research-center-medical-costs
Johns Hopkins just released a study that said " A 20-year decline in male circumcision has cost the country $2 billion in medical costs that could have been prevented." Interesting stuff.

No-I read the same article. I just didn't take it to mean what the other posters said. I read that they endorsed it and that it correlates to decreased cases of infection and cancer. The pp said that they said it was not recommended for all newborn boys. I took that to mean that it's not medically necessary and that while it isn't crucial, they still condone it. I think the other poster interpreted that paragraph differently than I did. And I interpreted her interpretation as the article being against circumcision. If that makes sense. Confused

littlewinnie15 · August 2012

Mom2Cinderella:
Estwd2:
Mom2Cinderella:
And am I reading a different article? I read that the AAP stated that the benefits outweigh the risks and that they endorse the procedure...
Are you thinking of this study?
 https://articles.baltimoresun.com/2012-08-20/health/bs-hs-circumcision-economics-study-20120820_1_male-circumcision-circumcision-research-center-medical-costs
Johns Hopkins just released a study that said " A 20-year decline in male circumcision has cost the country $2 billion in medical costs that could have been prevented." Interesting stuff.
No-I read the same article. I just didn't take it to mean what the other posters said.  I read that they endorsed it and that it correlates to decreased cases of infection and cancer.  The pp said that they said it was not recommended for all newborn boys.  I took that to mean that it's not medically necessary and that while it isn't crucial, they still condone it.  I think the other poster interpreted that paragraph differently than I did.  And I interpreted her interpretation as the article being against circumcision.  If that makes sense. 

I'm posting and running bc I'm about to be without Internet for the weekend, but I agree with your interpretations too.

I think it is essential that medical organizations make recommendations, and that those recommendations end up dictating what insurance covers. If WHO, AAP and others didn't make recommendations, I envision that insurance companies would stop covering routine care, as happened with the mamogram controversy recently, and other essential items like birth control. If that happened, we would find ourselves in a sh!tstorm of public health crises. Preventative care which, in my opinion, circumcision is, saves billions of dollars and lives. We need MORE coverage, not less.

Whether you agree with circ or not, studies show it prevents medical conditions and saves health costs down the line. Just like mammograms, birth control, physicals, etc. It's your right to choose it for your child, because yes, it's not a given that it will 100 save your child from future issues. But just as a woman with cancer in only one breast has the right to remove BOTH, those of us that want the option to circ to prevent or lessen the risk of potential infection, cancer and HIV should have the option to do it with insurance coverage.

smilelari · August 2012

I think I'm being mis-interpreted. I think theses orgs should make recommendations for diagnostics, treatments, procedures, etc. I just don't think they should make recommendations for coverage

And I read it as being the same old AAP stance. Slightly in favor, but mostly just neutral. Like they have been since forever.

Do you think a woman that doesn't have cancer at all should have the option of a mastectomy covered by insurance?

smilelari · August 2012

BTW, the reason I think these orgs shouldn't make coverage recommendations is that I want them to provide unbiased medical recommendations. The instant they start mixing insurance with the policies, it's politically charged, driven by the pocket book and no longer unbiased.

smilelari · August 2012

And FWIW, the stace from the AAFP is unchanged

https://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html

Mom2Cinderella · August 2012

I'm sorry Smilelari-I didn't mean anything by saying I misinterpreted you. I just meant that when I read over the original first few posts about the article and that insurance was no longer going to cover the procedure, I thought that the article was going to be against continuing the procedure-as in there wasn't enough evidence that there is benefit in doing it and that the benefits don't outweigh the benefits. Then I read the article and saw that they were favoring circumcisions and saying that it is beneficial. So in my head I couldn't figure out why insurance would stop covering something that the AAP is on board with. I did interpret the last paragraph differently. I take it to mean it isn't a medical necessity so if a family chooses to decline, they should have the right to do so and it's acceptable. So it doesn't recommend or urge ALL newborn boys have the procedure done as they do recommend for vaccinations.

There are many angles to consider when you are dealing with public health. With statements like this from the AAP, I don't think the government benefits financially from a opinion one way or the other.

FWIW-my husband won't even read the article because he is against circumcision and refuses to have it done if we ever have a boy. I have been arguing with him for years, but I could go either way on the issue. Although I'm more in favor of circumcision.

smilelari · August 2012

Mom2Cinderella:
I'm sorry Smilelari-I didn't mean anything by saying I misinterpreted you. I just meant that when I read over the original first few posts about the article and that insurance was no longer going to cover the procedure, I thought that the article was going to be against continuing the procedure-as in there wasn't enough evidence that there is benefit in doing it and that the benefits don't outweigh the benefits. Then I read the article and saw that they were favoring circumcisions and saying that it is beneficial. So in my head I couldn't figure out why insurance would stop covering something that the AAP is on board with. I did interpret the last paragraph differently. I take it to mean it isn't a medical necessity so if a family chooses to decline, they should have the right to do so and it's acceptable. So it doesn't recommend or urge ALL newborn boys have the procedure done as they do recommend for vaccinations.
There are many angles to consider when you are dealing with public health. With statements like this from the AAP, I don't think the government benefits financially from a opinion one way or the other.
FWIW-my husband won't even read the article because he is against circumcision and refuses to have it done if we ever have a boy. I have been arguing with him for years, but I could go either way on the issue. Although I'm more in favor of circumcision.

I'm personally opposed to circumcision and our son is uncircumcised

chele129 · August 2012

I do not interpret this article as the AAP saying whether or not insurance companies should cover the procedure. Right now some Ins co. will not cover it because they consider it an elective cosmetic procedure. In this case I interpret the word warrant to mean justified, as in there is medical justification (ie "prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV") and it is therefore not a cosmetic procedure.

smilelari · August 2012

Interesting blog on the subject

https://blog.practicalethics.ox.ac.uk/2012/08/the-aap-report-on-circumcision-bad-science-bad-ethics-bad-medicine/

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