Diminishing health insurance for obesity surgeries
Expect less health insurance coverage
for weight loss surgery
With more people electing to undergo
gastric bypass surgery, insurance carriers
are starting to feel the financial pain and
limit coverage.
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Obesity has the potential to bankrupt America
Obesity is a disease that threatens to become an
epidemic in the United States. When you consider the
obesity related illnesses and their associated costs
it is no wonder that insurance companies are now
starting to reduce and trim back health coverage for
this procedure in their health insurance plans.
Gastric Bypass Surgery is offered as the last hope for the morbidly
obese but the ironical part is the insurance coverage for weight
loss surgery is shrinking and proving to be inadequate to cover the
cost of weight reduction surgeries. A 2003 survey by Mercer
Human Resources found that among all employers and
employer-sponsored health plans, 77% do not cover obesity surgery.
Of companies with more than 500 workers and employer-sponsored
health plans, a whopping 52% do not cover it.
For those contemplating to exercise the last option of surgery over
traditional diet and exercise weight-loss regimens, this should be
an issue of serious concern. Especially, since the weight-loss
surgery does not come cheap. Bariatric surgeons concede that
cost of the Gastric Bypass Surgery could be anywhere ranging from
25,000-40,000 US dollars depending upon the experience of the
surgeon and the medical centre where one chooses to get the surgery
done!
The downsides of getting such an expensive surgery without an
insurance backup should be thoroughly considered before making the
final decision. The Centers for Disease Control and Prevention may
have warned that obesity is poised to become the leading cause of
mortality in the United States by 2005.
Yet, the truth is that the surgical treatment option for the ONE in
FIFTY Americans who have a BMI of 40 kg/[m.sup.2] or more--or are
more than 100 pounds overweight is not for all to exercise as the
insurance companies are not very keen to pay for obesity surgeries.
It is a reality that while nationwide the number of estimated
gastric bypass surgeries rose more than 500%, the insurance coverage
for the obesity surgeries is being trimmed.
Insurers claim they cannot afford to pay for surgery that they
believe to be risky. Obesity surgeries have a mortality rate of
0.3%, which may be on the rise because less-qualified doctors are
performing these operations. Obesity surgery is a very skilful
procedure and less experienced hands do run the risk of increasing
the mortality rate.
Experts too privately admit that surgery on obese individuals
carries higher risks as they are more susceptible to risks of
anesthesia during surgery and also to post-operative infections. The
mortality rate may increase if the obese patient also suffers
co-morbidities like hypertension, diabetes, and cardiovascular
disease. This effectively means that we are between the proverbial
‘rock’ and the ‘hard place’ as being obese is associated with
increased mortality itself! Surgical treatment is claimed to be the
only proven method of achieving long-term weight control for
morbidly obese people.
There does not seem to be enough incentive, however, to influence
the insurers to regularly cover obesity surgery, even if it may
lower their overall health insurance claims for other
obesity-related illnesses.
REFERENCES
(1) Mokdad AH, Marks JS, Stroup DF, Gerberding JL: Actual causes of
death in the United States, 2000. JAMA 291:1238-1245, 2004
(2) U.S. national employer-sponsored health survey 2003.
(3) Kazel R: Insurers trim bariatric surgery coverage.
(4) Lew EA, Garfinkel L: Variations in mortality by weight among
750,000 men and women.
(5) Gastrointestinal surgery for severe obesity: proceedings of a
National Institutes of Health consensus development conference.
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