Bariatric surgery is typically handled as a coverage rider rather than included in the umbrella policy. Therefore, rather than being carrier-driven, coverage is often employer-driven.

 

“It’s my understanding that approximately 55 percent of employers nationwide provide bariatric surgery coverage,” noted Pam Davis, RN, CBN, program director for the Centennial Center for the Treatment of Obesity, who added that coverage also exists under TennCare and Medicare. However, that still leaves a large number of Americans without coverage for surgical procedures that could have a marked impact on their health.

 

“For that reason, a lot of patients we see are self-pay,” said Davis. She added, “Our self-pay rate includes coverage for any complications or readmissions to the hospital related to their surgery.”

 

The Centennial Center for the Treatment of Obesity is the first in Tennessee to include such coverage through a partnership with BLIS. The included policy, BLISCare, is available to Bariatric Surgery Centers of Excellence as designated by the American Society for Metabolic and Bariatric Surgery.

 

Davis continued, “One of the drivers was that patients said they could afford surgery but worried what if complications came up they couldn’t afford. This takes the ‘what if’ out of play. It gives them peace of mind financially.”

 

Davis was quick to add complication rates are comparable or less than many other surgeries. “A gastric band performed at a Center of Excellence has a lower risk of mortality than a lap cholecystectomy (gallbladder removal) at a community hospital.”

 

The staff of the Metabolic Surgery Center at Baptist Hospital is also keenly aware of the financial concerns of bariatric patients. In late 2009, to compete with lower international pricing for Lap-Band weight loss surgery and in recognition of the weakened American economy, the center launched a “Lap-Band Wellness Stimulus Package.” Through the end of this month, the cost of the procedure has been reduced by 25 percent — from $16,100 to $12,000 — for self-pay patients. The package includes the basic surgical procedure (without overnight stay or additional measures related to complications) plus three months of Lap-Band adjustments and consultations with the center’s dieticians and exercise physiologists as needed. The center also offers financing options.

 

The $12,000 fee is competitive with medical tourism travel rates offered internationally but includes American quality and safety standards. Charles Morton, MD, medical director of the Metabolic Surgery Center, said, “In some places, medical qualification standards for physicians and healthcare facilities are very different than they are in the United States, and there’s no follow up care once the patient is back home.”

 

Dawn Gibson, office manager for the Metabolic Surgery Center, said she had been pleased with the increased volume and number of patients who have benefited from the discounted rate. “It’s resulted in increased traffic and phone calls into our center,” she said. “In the first six weeks of the promotion, 30 patients have been scheduled for surgery or are in the final phase of the scheduling process.”

 

She continued, “The 25 percent price reduction has helped make weight loss surgery a reality for many of these patients who have to cover the costs themselves. For those whose health insurance benefits do not cover weight loss surgery, paying for it is often a major factor in their final decision to have the surgery.”

 

Gibson added she expected to see interest and need grow this month as employers’ 2010 health plans begin. “Given the economy and rising health insurance rates, we believe some employers may have dropped the weight loss surgery option as part of their health benefits.” If so, even more patients would be left on their own to pay for bariatric procedures.

 

Although the cost is significant, for some patients, it’s the only viable option to return to a healthier weight and reduce or eliminate co-morbid conditions often associated with obesity. “Weight loss surgery is not for everyone and does require a lifestyle change,” said Morton. “For those who make the decision, they are investing in a healthier future.”

 

In addition to the reduced rate for the Lap-Band procedure, some patients might also be eligible for a non-reimbursed medical expense tax deduction. However, an accountant or other tax professional should be consulted before filing tax forms.