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salmonslayergirl | Should Ins. companies pay for gastric bypass surgery if lives are at risk and the surgeryis there best hope? |
Gastric Bypass surgery ( roux en Y ) has now been proven through long term studies to cure type 2 diabetes in 95 percent of patients. Reported on MSNBC |
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Kimche_Spicy
|
This is still a "hot topic" in insurance. There are many pros about gastric bypass and lap band intervention, which all are readily published and advocated.
However, insurance carriers are still very doubtful of its ability to be a too quick fix and long-term solution for justifying the cost of the surgery and follow-up care that comes with it as well as the potential of long-term permanent side-effects that can accompany it. Many companies want to see what you, the patient have truly done to make an effort to modify your lifestyle and eating habits prior to any approval. Medicare wants proof of 2 years of attempt of every available diet, nutritional modifications, and even psychological review prior to approval.
Another point of view of the cons is this....
It is now being proven that both are not permanent soltuions for permanent weight loss because many recipients of either surgery have had history of regaining weight, becoming alarmingly overweight, and having difficulty in losing it again. So even with the considerable stomach size reduction, one can still manage to become overweight with improper diet and exercise. This would be viewed by insurance companies as a monetary loss as it did little for long-term prevention.
Unfortunately, even after intervention surgery, it still comes down to self-control, behavior and eating modification, and life style changes involving exercise too.
NOTE: This question would probably best responded to in surveys & polls or health instead of insurance. Most insurance questions asked are regarding defintion of coverages or how to best use the insurance
EDIT ADD: Both of these surgeries should be viewed as the possibility of offering a quick fix to helping a person get on the right path for lifestyle modification when traditional methods may not have helped them to begin and to sustain if for the long haul. i.e. a overweight person labor of breathing and exercise stamina may be only 5-15 minutes. The dramatic weight loss resulting from the surgery will help mobility and breathing to help them maintain exercise for 20 minutes or longer as time passes and mobility continues to improve. Again, dietary moderation would always need to be observed. I do advocate the lap band as it is the least permanent types of surgery for those who have a clear understanding that this is not a permanent fix but only a tool to assist them for long term behavior changes. |
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sarah314
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The only way a person who meets the medical criteria for approval doesn't get covered is if their group (employer) chose to purchase a policy that excludes all weight loss surgeries.
*All* insurance companies offer policy options that provide coverage for weight loss surgeries under the appropriate medical criteria.
However, a group can choose to exclude weight loss surgeries regardless of medical necessity. If your employer chooses to negotiate a contract for a policy that doesn't cover weight loss surgeries, then that's their choice. (Often, employers have to pick and choose services in order to be able to offer benefits at all...which would be worse - every employee of the company doing without medical coverage entirely, or exluding those surgeries for the handful of people who might qualify/be interested? Those are the tough decisions HR/benefit people have to make sometimes.) |
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mbrcatz
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I saw that study . . .there were 97 people in it. Two years after gastric bypass, they lost an average of 45 lbs each. I don't think it's the gastric bypass that "cured" the diabetes. I think it's the weight loss. And I think there are safer ways to lose 45 lbs.
I think insurance companies should be free to decide if they want to cover it or not. Clearly, those that do will charge a MUCH higher rate for their policies, to cover the additional claims (kinda like maternity coverage, ya know?).
I want to see a study with a lot more people. And I want to know, five years down the road, will they gain all that weight back and re-develop type 2 diabetes? Dollars to donuts, the answer is yes. Permanent weight loss is only done by changing your habits. Period. The quick fix of gastric bypass is NOT going to be permanent, if the diet doesn't change, and excercise isn't undertaken. I do NOT want to pay extra health insurance premiums every month for a temporary fix. |
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TaxGurl
 |
The surgery doesn't cure diabetes. Changes in diet, exercise, and losing weight cure diabetes. I have a friend who did the lap band and made all of the recommended lifestyle changes. He is doing great and it was a good solution for him. His procedure was not covered by insurance.
A coworker had the lap band surgery, doesn't exercise, and eats junk food at her desk all day long. She wonders why she isn't losing weight. My company's policy covers this procedure and this was just a waste of insurance money for this individual.
Cosmetic surgery is never covered and a procedure just for losing weight shouldn't be covered either. I'd like my gym membership covered because it helps me maintain my health but no such luck! Surgery is never the best hope. Getting to the gym and working with a nutritionist are always better (less expensive) options. If you just have the surgery but don't modify the behaviors, you will gain it all back. If you learn how to exercise regularly and cook healthy, you will lose weight and maintain it. |
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mamatohaley+1
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I was overweight. You know what I did. I dieted and exercised. A lot cheaper than bypass surgery!! No they shouldn't pay for it. |
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acermill
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Absolutely NOT. Gastric bypass surgery is major, very expensive, and has many medical drawbacks to the recipient.
Furthermore, gastric bypass provides nothing which a carefully controlled diet cannot do. Gastric bypass merely eliminates the body's ability to absorb as many fats and nutrients as it normally would. A reduced controlled diet does the same thing.
Additionally, most patients will NOT qualify for gastric bypass unless they have undergone a moderated and controlled attempt at diet modification. |
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aaron p
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The problem is in the way the media reports things. Just because one study (or a few) says it might cure diabetes, does not mean that the data supports a causal link. The media is notorious for making stories about correlations in one study sound like there is a definite causal relationship. It's different.
It's not their fault. Remember, they get paid by advertisers, so they need to keep our attention with new fangled information to pay their bills, even if it's mildly misleading. Most Americans also have an informational bias towards the implications of media reporting, especially traditional media (I would include MSNBC in that group).
For something to be accepted as fact, several different studies need to show a causal link or MANY studies with different control measures would need to show a strong correlation. Otherwise, it might just be speculation or chance. Also keep in mind that the medical community and underwriting community do not see eye to eye on every issue because their goal is different.
Even if they were convinced that long-term, they may save money on these individuals, there is a financial disincentive to be the first one to freely offer gastric bypass. The amount of adverse risk that would jump on to the plan because of the new offering would mean the company either looses money or needs to price themselves out of competition.
In the end, we have a broken information system reporting on a broken health care system. Not good, huh? |
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