LoboLinks | It's a Big Deal...Weight Loss Surgery and Health Insurance

It's a Big Deal...Weight Loss Surgery and Health Insurance
Date Added: July 09, 2008 02:36:44 PM
Category: HEALTH: Health Insurance
Generally, when your physician tells you that you will need some type of surgery - there are very few questions asked by the health insurance provider. The hospital may need to get some type of prior approval before the actual day you are admitted, but very few insurance companies turn down a doctor’s request to perform a surgery. Most health insurance carriers assume that surgery is needed and waiting can only prolong pain and suffering. For the millions of Americans that suffer from morbid obesity and actually meet the criteria set up by the National Institutes of Health Consensus Development Panel concerning weight loss surgery, though, this isn’t the case. Insurance companies go the extra mile to protect their money.

The overall number of weight loss surgeries has increased incredibly over the last ten years. In 1994, only 16,200 bariatric surgeries were reported; that number in 2004 alone had increased to over 140,000. Many experts say that by the year 2010, the number could double again. The rise in weight loss surgeries over the past ten years is partly due to the increased number of obese patients. It’s no secret that the American public is growing in numbers and in size. As well, new research performed over the last decade proves that weight loss surgery for severely morbidly obese people can increase their life span. One such study performed in Canada followed a large number of obese patients for a time span of 16 years. A comparison was made between those that did have some type of weight loss surgery and those that did not. The results were astonishing; those not receiving surgery were associated with death rates four times their surgical counterparts.

So, why do so many health insurance providers deny or require stiff qualifiers for their carriers when it comes to weight loss surgery? Well, it’s all a matter of dollars, of course. Insurance providers know from their own statistics that most people will only use their services for an average of three years. So, even if weight loss surgery is a great preventative for patients as far as long term care goes- Insurance companies tend to look at short term. Another factor that plays a big role is cost of surgery. The average cost of weight loss surgery is $25,000 per person; that’s with an average hospital stay of just 2 days, as well. So as you can see, weight loss surgery is an expensive procedure. Insurance providers are usually privately owned and therefore must account for their spending; they are a business and must make money in order to stay afloat. If you have 2000 clients requesting a $25,000 weight loss surgery; even a profitable Insurance carrier can go bottoms up.

Today, many insurance providers are revamping their policy terms regarding weight loss surgery. Most likely the future will require patients to meet less stringent qualifiers, but will require patients to pay more of the expense. These private insurance carriers will most likely add “rider” with permit coverage but at a substantially increased cost to the insured.