Insurer Denies Surgery for Obesity
In March, the third-largest health insurance company in Massachusetts, Tufts Health Plan, will begin restricting surgery for obese patients. Before becoming eligible for gastric by-pass and stomach-banding procedures, some patients will be required to enter a one-year diet and counseling program. Details of this new policy can be found on the company’s website. Physicians are outraged at this new policy and state “there is a growing body of evidence that shows these operations help those patients who have exhausted other methods to lose weight.” In addition, many obese patients have already failed diet and counseling treatment programs. Dr. Scott Shikora, chief of bariatric surgery at Tufts-New England Medical Center said “the company should leave decisions about medical procedures to doctors.”
Tufts-New England Medical Center has been designated as a Center of Excellence by the American Society for Bariatric Surgery and is considered one of the largest weight loss surgery programs in the U.S. Since many insurers have traditionally reimbursed for these surgeries, bariatric centers can be sources of revenue for the hospital. Other insurers nationwide have attempted to restrict access to bariatric surgery and have met resistance from physicians, patients and obesity coalition groups. To be able to deal with an increasing number of obese patients, hospitals have to spend on upgrading man things from furniture to imaging devices.
February 15, 2007 Related topics: Bariatrics & Obesity