South Carolina insurers halt bariatric surgery reimbursement

More plans -- and some employers -- conclude the procedures are too costly and too risky for them to cover.

By Robert Kazel, AMNews staff. Oct. 11, 2004.

Additional insurers and employers are trying to reduce medical costs by halting reimbursements for gastric bypass surgery.

The board that runs the insurance plan for 370,000 South Carolina state employees, family members and retirees said in September it will decline to pay for the increasingly sought-after surgery starting Jan. 1, 2005. And BlueCross BlueShield of South Carolina decided to rescind coverage of the surgery for its 13,000 workers.

The self-funded South Carolina employee plan, which encompasses schoolteachers, public college employees, police and others, had paid for bariatric surgeries since about 1998. The state expects to save about $7.1 million a year by halting such coverage, said Mike Sponhour, a state spokesman. That was the amount the state Budget and Control Board spent in 2003 on 370 bariatric surgeries, or an average of more than $19,000 per case, he said.

BlueCross BlueShield of South Carolina, which administers the state plan, terminated coverage of gastric bypass operations for its own workers this summer after having covered it for about two years because "we've had very high rates of complications," said Ashby M. Jordan Sr., MD, the plan's medical director.

Karl Byrne, MD, a bariatric surgeon in Charleston, S.C., said it's arbitrary and shortsighted for payers to target bariatric patients.