Insurers trim bariatric surgery coverage

Pressured by employers, health plans are looking at cutting coverage of gastric bypass surgery and other procedures perceived as being high-cost and low-benefit.

By Robert Kazel, AMNews staff. April 5, 2004.

As America grows fatter, some insurers' coverage of weight-loss surgery is becoming leaner.

BlueCross BlueShield plans in Florida and Nebraska are among those who recently announced they no longer would cover gastric bypass surgery. CIGNA Corp. has stopped coverage in four states and is looking to withdraw coverage in more states as contracts expire.

It's not just bariatric surgery being targeted. According to the Center for Studying Health System Change, insurers, under pressure from employers, are increasingly looking at eliminating coverage for procedures perceived as high-cost and unnecessary.

But bariatric surgery is a particularly high-profile and popular procedure. Nationwide, the estimated number of gastric bypass surgeries -- touted by celebrities such as singer Carnie Wilson, TV personality Al Roker and "American Idol" judge Randy Jackson -- climbed more than 500% between 1993 and 2003, from 16,800 operations to more than 103,000, says the American Society for Bariatric Surgery. This comes as the proportion of Americans with a body mass index of 40 or more -- at least 100 pounds overweight -- increased fourfold between 1986 and 2000, from one in 200 to one in 50. Insurers that pay for the surgery typically require a BMI of 40 or more for coverage, or 35 for patients with serious comorbid conditions.

But firms cutting coverage say they can't afford to keep paying for what they see as risky surgery, with a reported death rate of three out of 1,000 procedures, that is increasingly being done by less-qualified doctors.