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Bariatric surgery insurance a weighty issue


A recent Associated Press article highlighted the situation of an obese woman who is unable to pay $15,000 for bariatric surgery not covered by her insurer. That woman is not alone. Although the number of obese people continues to rise, weight loss surgeries haven't increased. About 160,000 patients underwent bariatric surgery in 2013, almost the same number as in 2004.

Surgeons say the number one obstacle to weight loss surgery is insurance coverage. In fact, a survey from HealthPocket last year found 90 percent of more than 11,000 health plans didn't include coverage for weight loss surgery. And only 24 states require insurers to cover weight loss surgery in plans sold on the health insurance exchanges.

Losing weight isn't a simple cut-and-dry experiment. Sure, you can cut calories and increase activity, but it doesn't automatically guarantee long-term success. That's because our weight and body image have an inherently psychological aspect to them.

Just because you want to lose weight doesn't mean you think you deserve to be thin and have that knockout body you've been dreaming of. Often times, the key to weight loss isn't found within dieting and exercising; it's hiding behind therapy and lots of introspective work.

Being unwilling--or even just unaware--of the value of self-analysis in achieving weight loss isn't a "Get Out of Jail Free" card, however. These surgeries cost upwards of $25,000, so insurers must consider their effectiveness and long-lasting benefits before adding them to the list of covered services. What's more, studies have shown weight loss surgeries don't result in long-term savings as patients who underwent bariatric surgery still had average annual claims up to $9,900.

Susan Pisano, a spokeswoman for America's Health Insurance Plans, told the AP that "all major surgeries are risky." She added that weight loss surgery "is life altering, and if there is an approach that's less invasive and less risky for the patient, you want to try that one first."

She's right. One of the constructive steps insurers can take is offer help and counseling to members well before they get to the point where weight loss surgery is considered the only remaining option. Several insurers have already taken steps toward that end.

Blue Cross Blue Shield of Minnesota, for example, launched a set of anti-obesity TV ads that focused on the example that parents set for their children when it comes to eating healthfully. And Kaiser Permanente of Colorado has paid members cold, hard cash to lose a certain amount of weight and keep it off.

Insurers also can provide personal coaches to members in need of weight loss assistance. They can work one-on-one with people to motivate, encourage and educate them about all options available on their journey to better health. Cigna's collaborative accountable care program features health coaches who work with members on meeting a range of goals from quitting smoking to managing weight.

Most of the time, I advocate insurance companies should err on the side of more coverage for their members. Having access to a wide-ranging selection of medical services helps ensure consumers will obtain the healthcare they specifically need. And it's most advantageous for insurers to cover preventive services like coaching and offer wellness benefits like weight loss motivation programs. Members are more likely to take advantage of something that's already covered; and these services cost far less than surgery.

I hope to see more nutritionists, counselors and coaches listed as providers on insurance plans and more incentive programs that compel consumers into healthful lifestyles. That's a win-win for everyone. - Dina (@HealthPayer)