Susan Pisano, spokeswoman for America's Health Insurance Plans, the health insurance trade group, says that companies pulling back on coverage are simply being realistic. They can't possibly afford to pay for even a small percentage of obese Americans eligible for the treatment, she says. (Under the NIH standards, it's estimated that 20 million people around the country are candidates for weight-loss surgery.)
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Insurers limit obesity surgery
As more Americans become eligible for weight-loss surgery, many companies are phasing out coverage of the procedures.
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.
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She adds that many insurers are growing increasingly worried that some smaller hospitals and doctors have recently started performing the surgeries even though they are not qualified or don't have the appropriate equipment to treat the severely obese. One worry is that few small hospitals have items like oversized CT scans that are necessary to look at the abdomen in case of post-operative complications; typical machines can't handle patients over 300 pounds.
And, says Pisano: "Some of the newer surgeons doing this have only taken one weekend class, taught on cadavers or pigs, before they start operating. It's scary."
To help deal with that issue, the American Society of Bariatric Surgery recently began a program through which it will soon visit and review facilities around the country to see if they meet the society's safety standards. Blue Cross of California has started a similar plan for its enrollees.
In the meantime, advocates for the obese say they are preparing for a long brawl.
Walter Lindstrom Jr. of the Obesity Law and Advocacy Center in San Diego says that many groups are lobbying state governments and pushing laws similar to those in Maryland and Indiana that require insurers to pay for weight-loss surgery.
Lindstrom says many patients are also starting to sue insurers who turn them down. Some are using the argument that obesity is a genetic condition that can't be cured by behavior alone. "We are going to fight this with everything we've got," he says.
