Weight-loss surgery once was considered a rare measure of last resort. Now, tens of thousands of obese people a year are turning to such procedures, often out of frustration with more traditional attempts to shed excess pounds.
Faced with the daunting task of paying for all those surgeries -- estimated at more than $3 billion last year -- a growing list of insurers around the country are canceling coverage of the controversial procedures. In recent weeks, Kentucky-based Humana Inc. stopped covering the surgery and Blue Cross and Blue Shield of Florida announced it will do the same beginning in January. A number of other insurers have also walked away from paying for such operations in the past year, including UnitedHealthcare, the nation's biggest health insurer.
For The Record
Los Angeles Times Friday April 02, 2004 Home Edition Main News Part A Page 2 National Desk 4 inches; 138 words Type of Material: Correction
Obesity surgery -- An article Monday in the Health section about insurers limiting coverage of weight-loss surgery incorrectly attributed a quotation to Susan Pisano, a spokeswoman for America's Health Insurance Plans. The statement -- ''Some of the newer surgeons doing this [gastric bypass surgery] have only taken one weekend class, taught on cadavers or pigs, before they start operating. It's scary" -- should have been attributed to Dr. Peter Vash, medical director of the Lindora Medical Clinic in Costa Mesa. Also, a statement attributed to Pisano about the possible financial reasons for insurers declining to pay for the surgery mischaracterized her views on the subject. Pisano's point was that insurers are concerned that people are being recommended for obesity surgery who are not appropriate candidates for the treatment based on standards set by the National Institutes of Health.
For The Record
Los Angeles Times Monday April 05, 2004 Home Edition Health Part F Page 5 Features Desk 4 inches; 138 words Type of Material: Correction
Obesity surgery -- An article in last Monday's Health section about insurers limiting coverage of weight-loss surgery incorrectly attributed a quotation to Susan Pisano, a spokeswoman for America's Health Insurance Plans. The statement -- ''Some of the newer surgeons doing this [gastric bypass surgery] have only taken one weekend class, taught on cadavers or pigs, before they start operating. It's scary" -- should have been attributed to Dr. Peter Vash, medical director of the Lindora Medical Clinic in Costa Mesa. Also, a statement attributed to Pisano about the possible financial reasons for insurers declining to pay for the surgery mischaracterized her views on the subject. Pisano's point was that insurers are concerned that people are being recommended for obesity surgery who are not appropriate candidates for the treatment based on standards set by the National Institutes of Health.
Employers and the self-employed can continue financing the procedures by paying higher premiums, but benefits experts say the majority of them aren't doing so.
"We are concerned about the overuse of this procedure, especially considering the lack of assurance that it's both safe and effective in the long run," says Barry Schwartz, vice president of care at Florida's Blue Cross. Schwartz estimates his company would spend more than $200 million in the next few years if it didn't change course.
According to the American Society for Bariatric Surgery, the number of weight-loss operations jumped to more than 100,000 last year, up from 16,000 in the early 1990s.
The insurance industry's recent change of heart is leaving many morbidly obese people at a loss for what to do now. At 5 feet, 6 inches tall and 550 pounds, Richard Sepeda, 32, suffers a litany of problems more appropriate for someone twice his age: high blood pressure, diabetes, bum knees already propped up by recent reconstructive surgery.
Worse, he says, is the emotional toll. His latest round of depression in December was his most severe yet. "I wonder what it would be like to be normal and live a normal life," says Sepeda, a Lockhart, Texas, police dispatcher.
Although Sepeda wants gastric bypass surgery, his insurance won't cover it and he can't afford to pay for the $30,000 surgery on his own. He has hired a lawyer to appeal the decision but if he loses, which he acknowledges is likely, he and his wife, Marilyn, may sell the house they bought three years ago to pay for the surgery. "I have to do something or I am going to end up dying before I'm 40," he says.
