What to pay for?
Some states including Utah are considering mandating Insurance companies to cover gastric bypass surgery for morbidly obese residents.
The Utah legislature will consider a bill in the session that begins Jan. 15. It is being raised because a 386-pound man named Jeff Haaga urged his local state representative, Steve Mascaro, to sponsor the bill.
He reported his physician told him he would die if he doesn’t lose weight, but there is not much information about what the patient has tried or has been advised.
The patient believes the insurance company would save money by paying for the $17,975 surgery rather than covering all the care for health problems related to his obesity. These could include heart attacks, strokes, knee and hip replacements, and diabetes management.
What this patient doesn’t understand is that from the Insurance perspective, they know that on average, companies only stay with the same insurer for 2-3 years. Therefore, the insurance company would not be saving these dollars in the long run because the patient will likely be covered under another plan. It is to their financial benefit to deny services knowing many times the complications will occur when the patient is under another insurance plan.
Maryland and Indiana already mandate payment for the surgery.
The mandate is a concern for all insurance companies. Many offer it as an option that companies can choose as part of their benefit programs. But a mandate would then cause premiums to rise and many companies may not be able to afford any policies for their employees.
These types of issues get to the heart of the problem. What is considered basic medical care?
What should be covered and what should be an “add-on”?
The Utah legislature will consider a bill in the session that begins Jan. 15. It is being raised because a 386-pound man named Jeff Haaga urged his local state representative, Steve Mascaro, to sponsor the bill.
He reported his physician told him he would die if he doesn’t lose weight, but there is not much information about what the patient has tried or has been advised.
The patient believes the insurance company would save money by paying for the $17,975 surgery rather than covering all the care for health problems related to his obesity. These could include heart attacks, strokes, knee and hip replacements, and diabetes management.
What this patient doesn’t understand is that from the Insurance perspective, they know that on average, companies only stay with the same insurer for 2-3 years. Therefore, the insurance company would not be saving these dollars in the long run because the patient will likely be covered under another plan. It is to their financial benefit to deny services knowing many times the complications will occur when the patient is under another insurance plan.
Maryland and Indiana already mandate payment for the surgery.
The mandate is a concern for all insurance companies. Many offer it as an option that companies can choose as part of their benefit programs. But a mandate would then cause premiums to rise and many companies may not be able to afford any policies for their employees.
These types of issues get to the heart of the problem. What is considered basic medical care?
What should be covered and what should be an “add-on”?
posted by Anonymous at 5:55 AM
4 Comments:
Great question. Unfortunately, I am afraid the answer is out of my league. I know that has not necessarily stopped me in the past.
"I know it when I see it" is my best answer.
If the health insurance companies won't pay for weight reduction programs as an alternative to surgery why should they pay for surgical procedures?
paitent compliance to a healthy lifestyle for 1 year prior to surgery should be the standard. If all other means of weight reduction is explored first and the paitent is compliant with diet and lifestyle changes then I say the insurance co. should cover it as a treatment option. after all, to get a transplant you have to adhere to strict compliance with medical treatment and undergo psychological and medical evaluation before being placed on the list.
Maybe the insurance companies should pay for monthly gym fees and personal trainers as an alternative. That would probably be a much cheaper solution and healthier for the patient
Or maybe Medicaid should pay for gastric bypass. How long will private insurance pay for someone who is forced into a nursing home after a massive stroke? Not long...It seems like we see CHF, CVA and/or diabetes on nearly every person's chart in long-term care, and the vast majority of nursing home residents are on Medicaid. In the long run--for those who live long enough--chronic conditions like these end up costing more money in state/federal dollars than a private insurance company would ever be likely to pay.
If we go this route, since one can't get gastric bypass for being 50lbs or so overweight, maybe we should also tax people so many dollars per pound over healthy BMI on a quarterly basis, and funnel that money into individual "See, we told you this would happen" accounts (something akin to long-term care insurance).
I wonder how many of us would remain exempt.
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