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Weight Loss Surgery Coverage Push

More obese Americans may be given the opportunity to have their weight loss surgery covered by insurance if device manufacturers have their way. Allergan Inc., makers of the LapBand gastric banding device, has been the most vocal in their efforts to give obese patients access to this life-altering surgery. Weight Loss Surgery Coverage PushBeing able to have this surgery covered by insurance will give patients the tools they need to fight a host of life-threatening illnesses brought on by their obesity. Allergan proposes that allowing more people access to insurance coverage will save billions of dollars in healthcare costs for both the government and employers.

The Dilemma

Critics argue that bariatric surgery has high rates of complications which can reach into the thousands and that the surgery doesn’t change the underlying behavior.

Allergan Chief Executive David Pyott said that it’s all about reimbursements. The benefits of weight loss surgery are not well understood by policy makers. Pyott is in Washington, meeting with lawmakers to discuss including bariatric surgery in the package of standard benefits that all insurance plans must offer under the 2010 Affordable Care Act health system overhaul.

Allthough LapBand is only one type of bariatric surgery, Allergan is pushing for all bariatric surgery methods to be included in the coverage. Other methods, which include gastric by-pass, gastric sleeve and other banding options, may be more complicated and take more healing time, but Allergan feels that if they push for coverage of all types, both private and public insurance would most likely approve the entire category.

Coverage Hurdles

Nearly 73 million Americans are considered obese, meaning they have a Body Mass Index (BMI) of more than 30. In a recent survey by Hewett Associates of U.S. employers, 45 percent cite obesity as one of the most significant health concerns for their businesses. Of those surveyed, 44 percent with 5,000 or more employees do not cover bariatric surgery.

Most employers do not cover bariatric surgery, for those who do; several pre-requisites exist before the employee will even be considered for approval, including higher co-payments of $5,000 to $7,500.

“If you’re making $25,000 a year and you have a $5,000 co-pay, that’s 20 percent of your salary,” said Joseph Nadglowski, President and CEO of the Obesity Action Coalition, a patient advocacy group. “High co-payments and the hoops and hurdles insurance companies put in front of surgery is limiting.”

Potential patients are urged to try diet and exercise before applying for coverage and to use the surgery as a last resort. However, Gus Georgiadis, president of Triad USA, an employee benefits services and consulting firm, says that diet and exercise at a BMI of 35 or greater will fail more often than it will succeed.

January 25th, 2012

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