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Dec 5, 2013 8:12 AM by Elizabeth Hill

Insurance coverage a challenge for patients seeking weight loss surgery: Part 1

People in Louisiana are digging deep in their pockets to pay for weight loss surgery.

Without insurance, out-of-pocket costs can be anywhere from 10 to 35 thousand dollars.

"It costs the state 100's of millions of dollars to treat obesity and it's becoming more of an epidemic in the state of louisiana," says Senator Fred Mills.

At 34.7%, louisiana has the highest rate of obesity in the country barely passing previous number one Mississippi at 34.6%.

It's a growing problem nationwide and one not only affecting our health, but also our wallets.

It's estimated, obesity related medical treatments cost between about $150 and over $200 billion a year nationwide.

For some people battling obesity, bariatric surgery is a good option to help them lose significant weight and resolve health problems like diabetes, hypertension.

Unfortunately, in Louisiana, most insurance companies don't cover the surgery.

In 2010, Senator Fred Mills, co-sponsored a resolution that prompted the Office of Group Benefits to conduct a study on weight loss surgery.

The five year study, in it's third year, will include 500 patients covered by state government insurance and look at the cost of surgery versus the cost of treating obesity related health problems.

"A study like this will hopefully be smarter about attacking obesity and will also be more cost efficient and be able to use money for preventative care instead of this type of disease state," says Mills.

A legislative mandate on insurance companies to cover bariatric surgery could have big implications, especially now under the Affordable Care Act.

"The state would have to fund the cost of that mandate to the insurance companies that would pick up that responsibility," says Louisiana Insurance Commissioner Jim Donelon.

The up front cost for insurance providers is why many are hesitant to provide coverage.

"If they invest $25,000 or $26,000 or whatever the cost is for bariatric surgery and that client may not be in the book of business for the insurance company, so you may make that investment short term, but will you get the long term results," says Mills.

"The state would not receive much in the way of relief, if you will, or benefit other than having, perhaps healthier citizens in the state from that expenditure," says Donelon.

In another study by the Office of Group Benefits from 2004 to 2008 results showed that the surgery group made an average of $25,896 in medical claims, compared to the $8,662 average for the obese non-surgery population.

Four years later, the surgery group made an average of $4,897 in claims, compared to $7,718 for the obese non-surgery population.

While it may cost more upfront, the study shows patients who underwent surgery did cost less in the long run.

"The state would see very little of that," says Donelon.

Whether or not legislators elect to mandate coverage for bariatric surgery, obesity is a problem we've yet to find a solution to. In 1980, no state had an obesity rate of 15% or more. In 2013, 41 states have obesity rates of at least 25%.

"As obesity becomes more rampant, more blood pressure problems, more diabetic problems, more arthritic problems and it's preventable if we can attack the disease at the obesity state," says Mills.



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