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Dec 5, 2013 8:52 AM by Elizabeth Hill

Insurance coverage a challenge for patients seeking weight loss surgery: Part 2

"Life is so much more comfortable."

Since undergoing gastric sleeve surgery a little over a year ago, Wayne Reiners has lost about 140 pounds.

"I do a good bit of hunting, I would have to basically double brace ladder stands to support me and now you could say I can buy them off the shelf."

Not only is Reiners more comfortable, but also more healthy.

"Medicines have been cut out, others have been cut back on the dosage."

Reiners says prior to surgery he suffered from hypertension and was borderline diabetic.

Extreme weight-loss is the only known cure for many medical conditions related to obesity like diabetes, hypertension and sleep apnea.

Reiners is among the 60% of individuals who pay cash at the Bariatric Surgery Center at Lafayette General. He says he was surprised to learn the surgery was specifically excluded from his particular insurance plan.

"You have to figure they're going to come out ahead over the long term with the probability of reduced hospitalizations from cardiac problems, and way less on the medicine."

"The insurance companies are seeing a great benefit of now having healthier patients without having to assist the patient with achieving the healthier lifestyle."

Bariatric surgeon Dr. Philip Gachassin says it's heartbreaking to see patients who come to him ready for the surgery, but unsure how to pay for it.

"The biggest complaint I get often is from parents, grandparents, that they can't play with their children or grandchildren."

While the upfront cost for surgery is high, studies prove the long term benefits typically mean lower costs for insurers.

"the insurance company is spending a lot of money on their medical problems, but they won't assist them with covering the one thing that has been shown to make a difference in their survival."

Gachassin says this sort of cost-benefit analysis isn't used for any other disease.

"Say you have cancer and there's an operation that can cure you of cancer, the insurance company does not say well how much money is that going to cost us and are we going to make our money back because this patient no longer has cancer."

Reiners says he was fortunate to be able to pay cash for the procedure and did not experience any complications, but he says it still takes work to maintain the weight loss.

"it is not a cure all, you still have to work at it."

In order to be a candidate for weight loss surgery, a person must have a body mass index of at least 35 along with a condition like diabetes, hypertension or sleep apnea or, a candidate must have a BMI of at least 40, regardless of other conditions.

Doctors estimate there are about 30 million candidates for weight loss surgery in the US, but only about 175 thousand surgeries are performed each year.



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