Changing Trends Regarding Insurance Cover For Weight Reduction Surgery

Bariatric surgery is a term derived from the Greek words: ''weight'' and ''treatment.'' Bariatric surgical procedures are major gastrointestinal operations that either seal off most of the stomach to reduce the amount of food one can eat or rearrange the small intestine to reduce the calories the bodies can absorb. It is a collective term given to the various surgical options available for treatment of obesity.

Bariatric surgery is now becoming common place with more and more number of people interested in losing weight in a drastic way. As the demand for bariatric surgery continues to increase, employers and insurers are increasingly forced to make or revisit decisions about whether or not to provide insurance coverage for the cost of the procedure.

Several studies have been conducted on whether an insurance cover for such type of a surgery is necessary. It is estimated that the return on investment associated with an employer’s decision to provide some level of coverage for bariatric surgery and the demand for such surgeries is based on various out-of-pocket costs.

In a recent study conducted, it has been found out that nearly 9 percent of all full-time employees are eligible for bariatric surgery based on existing guidelines. Because of their high medical costs and increased absenteeism, approximately two-thirds of costs attributable to obesity are incurred by those eligible for bariatric surgery. It would likely take between five and 10 years for an employer to recover the full cost of the surgery.

The second study used an Internet survey of obese individuals to determine that about 150,000 bariatric procedures per year would be demanded by those with private health insurance at an out-of-pocket price of $25,000. Even when fully covered by insurance, the results suggest that demand among those with private insurance would not exceed about 375,000 procedures per year among full time employees. These estimates allow insurers and employers to make more informed decisions about the financial impact of offering coverage for bariatric surgery. More research is however indicated to address the cost concerns associated with the surgical procedure.

Financial implications are one of many factors considered in the decision to offer coverage for specific treatments but that as the prevalence of morbid obesity increases, employers will be forced to look for cost-effective strategies to improve the health of their employees.