State Lawmakers Consider Mandating Coverage for Obesity Surgery
Lawmakers in Connecticut and other states are considering requiring health insurers to cover obesity surgery, the AP/Virginian-Pilot reports. A proposal before the Connecticut Legislature would require insurers to cover obesity surgery for state residents with a body mass index of 30 or more if a doctor says the procedure is medically necessary. State lawmakers in Georgia are considering similar legislation, and 40 state employees in Louisiana last year received the surgery under the state's employee health plan.
However, the proposals remain controversial, the AP/Virginian-Pilot reports. The Connecticut proposal has an uncertain future, as lawmakers work to define the medical conditions under which obesity surgery should be covered, according to state Sen. Joseph Crisco (D). Some lawmakers and health insurers also have expressed concern about the risks of obesity surgery, which has a complication rate of 20%. Some health insurers -- including BlueCross BlueShield of Alabama and BCBS of Florida -- in recent months have stopped covering the surgery, which costs $20,000 to $35,000.
Other insurers offer coverage in plans covering a large number of employees or limited coverage of the surgery. "What we're starting to see is an increase in what we would consider, at best, unnecessary, and, at worst, unsafe surgery," Keith Stover, a lobbyist for the Connecticut Association of Health Plans, said. He added, "Many plans decide the best course of action simply is to exclude coverage." However, many physicians say the long-term benefits of the weight loss achieved through obesity surgery outweigh the risks, the AP/Virginian-Pilot reports. The surgery also can reduce the long-term cost of medications to treat conditions related to obesity, such as hypertension and diabetes (Gillespie, AP/Virginian-Pilot, 3/22).