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Insurance Companies hesitant to pay for Weight Loss surgery

Citing lack of long term studies and rates hikes, some insurance companies remain hesitant to cover Weight Loss Surgery (WLS).  The average procedure costs about $15,000-$40,000 but an insurance spokesperson pointed out that as high as 10-20 percent of gastric bypass patients require return visits to the hospital for repair or revision surgery.

It's hard to find a study where patients have been physically examined and not just talked to on the phone," said Dr. Donald Thieman, vice president for medical affairs, Regence BlueCross BlueShield of Oregon, one of the several companies which does not cover WLS.

Dr Keith Bachman, an internal medicine department physician at Kaiser Hospital in Oregon, who also facilitates support groups for pre- and post- operative patients stated that about 20 percent of WLS patients regain the weight they lost. Kaiser performs between 100 and 150 of the operations annually, Bachman stated.

Health insurance companies which do not cover Weight Loss Surgery in most cases include Health Net, Regence BlueCross BlueShield of Oregon and PacificSource.

Some advocacy groups have formed to try to get more insurance coverage but questions about the long term efficacy of WLS and especially gastric bypass surgery, remain prominent even WITH the AMA which instructs its physician members to not take patients except if recommended by their PCP and to inform patients that Weight Loss surgery is investigational and it is unknown whether it will help that patient.

News sources online:

http://portland.bizjournals.com/portland/stories/2003/08/25/story4.html?page=2

Source for AMA comments about Weight Loss surgery:

1762 JAMA, April 9, 2003-VoL 289, No. 14

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