Friday, March 23, 2007
Footing the bill for gastric bypass
It seems Anne was always an active person. As a hot-shot consultant, she liked to travel both for work and pleasure. But as the years went by, she began to have a lot of pain in her joints and was eventually found to have an autoimmune disease. She stopped exercising, went on medication and began to gain weight, lots of it. She became so heavy that she had to use a motorized scooter to get around. She couldn't take walks with her husband. She wasn't enjoying her life. She was desperate. Her doctor finally suggested she think about bariatric surgery to rid herself of the weight. She had the procedure and within months became mobile and her illness went into remission.
Anne Durand is not alone. According to the American Society of Bariatric Surgery, more than 177,000 patients had gastric bypass or stomach banding procedures last year. Intended to help people who are considered severely obese or suffer from complications because of their weight, the surgeries can be expensive as well as dangerous. And those are two things insurance companies don't like to hear. Susan Pisano, a spokesperson for America's Health Insurance Plans says insurers want patients to understand that bariatric surgery is not a quick fix and that there are other alternatives.
Now, some insurance groups are insisting on more then just a doctor's opinion and a patent's desire before they'll agree to pay for these procedures. Beginning this month, Tufts Health Plan in Massachusetts is requiring some obese patients to enter a yearlong diet and counseling program before undergoing bariatric surgery. Tufts' hope is to have patients lose their weight naturally, without surgery. But some doctors feel the policy just postpones the inevitable. According to NIH research, only about 5 percent of patients, once they are morbidly obese, are able to lose weight by willpower alone. And other surgeons believe it's none of the insurance companies' business to tell people what surgeries they can or cannot have.
But Tufts Health Plan is not alone; many insurance companies say it is their business to oversee their clients' health. They insist that many patients who seek these surgeries can lose weight without going under the knife. They also stress that these procedures are risky and it's a safer tactic to wait out the surgery for a year, than to jump into an operation that many patients don't understand.
Had Anne Durand waited a year to have her surgery, chances are she would have not been able to walk. She cringes when she thinks about it. But insurers say that she's an exception and that many of those who have bariatric surgery could look to better nutrition and exercise as a solution to their obesity.
What do you think?
For more on bariatric surgery, watch House Call with Dr. Sanjay Gupta Saturday and Sunday at 8:30 a.m. ET
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