Insurance companies debate bariatric surgery

Tom Barry

Contributing Writer

One skirmish in the battle over obesity involves gastric bypass surgery, in which the stomach is stapled and made smaller, limiting food intake and often leading to substantial weight loss.

Increasingly, insurance companies are declining to pay for gastric bypass (bariatric) surgery among the morbidly obese, unless a rider to the customer's policy expressly provides for the coverage, usually at a higher premium.

The surgery typically costs $20,000 to $25,000, and insurance carriers argue the proliferation of procedures is driving up the cost of health insurance for everyone. They also contend critical pre- and post-operative counseling often is lacking and serious medical complications can ensue.

Gastric bypasses are increasing at a rate of 40 percent a year for a simple reason, said Dr. Harvey Sugerman, president of the American Society for Bariatric Surgery. "The surgery works, and nothing else does for these unfortunate individuals. It dramatically decreases their medical problems and can save lives."

Aetna Inc. changed its policy a year ago. Clients who want the coverage now must pay extra.

"Our customers were very concerned about the number of procedures being done as well as the growing cost," said spokesman Walter Cherniak Jr. "Employers, particularly smaller companies, were concerned about the effect on premiums. The surgery should be seen as a last resort, not a first one, and those having it should be good candidates for it."

Blue Cross and Blue Shield of Georgia Inc. stopped paying for the procedure as part of its general coverage last fall but is considering offering it as a rider.

"It was the expense and sometimes uneven (surgical) results," said spokesman Charlie Harman. "We're now looking at offering it as a rider, and hope to have that option available later this year."

Rep. Nikki Randall, D-Macon, recently introduced legislation in the Georgia House to require that insurance companies pay for the treatment of morbid obesity, defined as at least 100 lbs. overweight or twice the ideal body weight. Gastric bypass surgery would be in the mix. This bill did not pass this year.

Sugerman said studies have shown the surgery pays for itself in three and one-half years because patients subsequently experience far fewer medical problems.