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Should health insurance pay for bariatric surgery?

Posted: November 27, 2011 - 1:00am

Should health insurance programs pay for stomach stapling for fat people?

Stated as insensitively as possible, that’s a major philosophical question right now for Columbia County. The county government’s health insurance won’t pay for it, and after the first of the year the school system’s plan no longer will, either.

Other health insurance programs from private employers are all over the map on the issue, but those two government entities also are two of the area’s largest employers, so their direction is significant.

This issue probably isn’t on the radar screen for most people. If you aren’t morbidly obese, or close to someone who is, you probably haven’t given it much thought. I have a couple of friends who have found great success with the procedure, but I haven’t given it much thought.

Dr. Paul Fischer has. He’s a well-known Augusta physician and was instrumental in kicking Joe Camel out of cigarette advertising. He’s also in the midst of a legal challenge to some of the nonsensical reimbursements from federal health insurance programs. (I’m also a patient of his at Centers for Primary Care.)

So he thinks about this sort of thing in a big way. And he’s frustrated that the insurance companies think about it only in the smallest ways.

He explains it like this: Gastric bypass, or stomach-stapling, or whatever you want to call it, is a surgical last resort for the morbidly obese – and there are more and more morbidly obese people each year. The surgery makes it all but impossible for the patient to consume more calories than he or she can burn, and the resulting weight loss can be dramatic.

It’s also life-saving. Patients who go from being morbidly obese to being closer to optimal body size are far less likely to have heart problems, they don’t become diabetic (or, if they already were, it quite often reverses the condition and its physical damage) and they no longer have impaired mobility.

In short, they’re healthier. Because they’re healthier, their health-care costs decrease dramatically.

So: The $15,000 one-time expense of bariatric surgery, Fischer says, typically is paid back in less than five years with the elimination of all the pharmaceuticals and medical care necessary to keeping alive someone who is morbidly obese.

Insurance companies, however, would rather pay thousands of dollars, each year, every year, to help patients stay alive but morbidly obese, instead of paying a higher, one-time cost to make them healthy.

Look at it in a way that hits closer to home: The insurance companies you help fund with your taxes would rather spend thousands of dollars each year on blood-pressure medicine and diabetic supplies than make individual investments that in the future could save you money.

So even if we’re insensitive to fat people, we must really like them – because we’re paying to keep them that way.

(Barry L. Paschal is publisher of The Columbia County News-Times. Email barry.paschal@newstimesonline.com, or call 706-863-6165, extension 106. Follow at twitter.com/
barrypaschal.)

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Comments (3)

Riverman1

Statistics for Weight Loss Surgery

I've lost 70 lbs over the last couple of years and have managed to keep it off via my diet, mild exercise and decreasing alcohol consumption so I have a different view. I believe this method is superior to weight loss surgery when the statistics are reviewed.

About 80% of weight loss surgery patients regain some weight back while 30% gain all their weight back. Anecdotal I realize, but I work with two ladies who had the surgery and both gained all their weight back within 3-4 years.

Complications from the surgery are about 10% to 20%, depending on the study, with patients requiring FOLLOW-UP SURGERY. About 30% of the patients develop problems such as anemia requiring ongoing medical care forever.

Another very real complication that is now being recognized is addiction transfer for these patients. Without psychiatric care many will transfer their addictions to other negative activities.

As you can see, it is debatable whether this is a cost effective procedure to lower long term medical care costs.

Riverman1

Weight Loss Surgery Facts

oops...duplication.

Eggface

I was insured through my

I was insured through my workplace, had a BMI of 54 (super morbidly obese) with several health issues - severe GERD Gastroesophageal Reflux Disease, severe Obstructive Sleep
Apnea, High Blood Pressure, and a host of other issues related to obesity, all of which were being treated by my doctors and costing my insurance company and myself thousands and thousands of dollars. All the while I was repeatedly denied any weight loss related treatments: no weight loss or fitness programs, nutrition classes, pharmaceuticals, therapy, nothing related to the treatment of weight loss was covered and I was denied weight loss surgery even though I was told by my doctors that many of the painful, debilitating, and life threatening conditions impacting my health would be potentially relieved and that having weight loss surgery was the best option.

I've since self paid for weight loss surgery. My before and after http://www.theworldaccordingtoeggface.com The 158 pound weight loss I achieved resolved all my health issues, I am off all 8 medications I was on prior to surgery, I have not been to the doctor for anything more than routine check-ups in the 5 years since surgery - all of which are a considerable savings to my insurance company. I hope to continue to live a healthy life and am happy with my decision to self-pay thankfully I was financially able to but merely saying lose weight without giving people the weapons to fight is not going to win this war against obesity.

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