As many who read this blog surely know, getting insurance to cover bariatric surgery has been a difficult battle in the past.  Most insurers have bariatric carve outs or total exclusions for many, if not all, of their plans.  This is changing slowly, but there are signs of hope for those currently awaiting coverage.

The first thing to look at is the increasing amounts of data pouring into the market.  As time goes by and more people have surgery, the more data gets into the hands of insurers who determine what is covered and employers whose demand for various services often leads to coverage policy changes.  So far all of that data has pointed to increased healthcare costs for those with BMI >35 which is getting the attention of HR managers looking to cut the costs of their plan.

 

a graph comparing the increase in health related costs for overweight vs. obese people

The second is that some insurers have already made the decision to start covering the gastric sleeve.  This is important primarily because the insurance world is a very “follow-the-leader” type place.  Meaning when one large insurer does something, it generally causes others to do the same to keep up.  The May issue of Bariatric Times contains an article noting the ASMBS’s support of the recent decisions to cover the gastric sleeve by both Aetna and United Healthcare.  Definitely a good sign going forward.

Though there is a lot of work left to do before weight-loss surgery is treated as a necessary medical procedure, there are positive signs on the horizon.

If you have questions about your bariatric insurance coverage, we are happy to help whether or not you are a current patient with us.  Give us a call today!