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Weight Loss Surgery Saves Lives – Why Don’t Insurers Cover It?

Written by Consumer Guide to Bariatric Surgery   Last modified on October 16, 2018

This much we know: Weight loss surgery not only saves a lot of money but also improves quality-of-life and extends life expectancy. But now the exact benefits have been quantified.

The lifetime cost saving associated with having weight loss surgery is $28,999 per patient. Every diabetic weight loss surgery patient gains an extra 3.7 years of life; every patient who has developed heart disease gains an extra 3.4 years of life; every patient who has developed fatty liver gains an extra 3.7 years of life; and patients who have developed high cholesterol gain approximately one extra year of life. These are among the main findings from a new study out of MedUni Vienna study, conducted with the Institute of Pharmaceutical Economic Research and the Austrian Society of Bariatric Surgery.

Still, just one or two percent of people who qualify for bariatric surgery in the U.S. actually get the operation, and the same holds in other countries.

Given these cost and health savings, it begs the question… What gives?

One of the biggest barriers to care is money. Insurers — including those in the states with the highest rates of obesity — are not willing to foot the bill. Gastric sleeve costs between $20,000 and $35,000 without insurance, and the cost of other weight loss surgeries is comparable.

In Mississippi, more than 37 percent of adults are obese, but Mississippi is also one of two states (along with Montana) that doesn’t cover bariatric surgery in its Medicaid program. What’s more, many states don’t cover the procedure in their state employee, or Obamacare plans, according to the American Society for Metabolic and Bariatric Surgery (ASMBS). Obamacare enrollees in Arkansas, the third most obese state, also can’t get bariatric surgery.

In a thought-provoking article in the Atlantic, The Obesity Cure Is Out of Reach in the Heaviest States, the author writes that these procedures are “treated by insurance companies less like a life-saving treatment and more like a nose job: frivolous and optional.”

What’s more, “even in a state where there’s technically coverage, there are so many barriers to getting surgery, it’s like not having coverage at all,” says Scott Kahan, M.D., the director of the National Center for Weight and Wellness in Washington, D.C. Hurdles include not gaining any weight during the three-month preoperative phase — which is clearly a challenge — or failing at weight loss methods for 6 to 12 months.

This does not mean you are powerless. Our article on insurance gives you the best chance at getting your insurer to cover the costs of your weight loss surgery.  

Let us know if you have run into any hurdles or have any tips to share on getting your life-saving surgeries covered by insurance.