Insurance companies' attitude toward weight-loss surgery isn't sensible

I am a nurse practitioner in a weight-loss clinic and prepare people to have weight-loss surgery. The most challenging obstacle those patients face is not what you’d think.

The biggest obstacle? Their insurance company.

Patients come into the clinic for a consultation only to find out that there are so many hoops set up by their insurance company that it can make it almost impossible for them to have life-changing surgery.

Insurance companies put up roadblocks, such as requiring psychological evaluations, three to six months of medically supervised weight loss and counseling, and documentation for two years of failed weight-loss attempts – all for the purpose of reducing the number of surgeries they have to pay for each calendar year.

Patients come to clinics having agonized for years about their weight-loss attempts and failures. Many have tried every commercial, fad and totally whacked-out diets, trying desperately to get their weight under control and spending hundreds, even thousands, of dollars in the attempts.

This is not for vanity reasons. For most of my patients, how they look is very low on the priority list. Their No. 1 reason for wanting weight-loss surgery: to be healthy.

Obesity contributes to a host of chronic diseases, such as diabetes, high blood pressure, heart disease, obstructive sleep apnea, severe mobility issues and some cancers. Studies show that obesity shortens life expectancy by three years and morbid obesity by 10 years. Diabetes will add an additional $6,600 per year to the cost of an individual’s health care, more than $400,000 over a lifetime.

Call me crazy, but I would think that treating a contributing factor to diabetes would be a smart investment for insurance companies.

It comes down to nomenclature and semantics. Obesity “contributes” to a host of diseases, but Washington state does not recognize obesity as a disease. As a matter of fact there is considerable debate about whether or not obesity is or is not a disease. And that is the out-clause for the insurance companies; they don’t have to treat obesity because it is not considered a disease.

I recently saw a patient who was getting ready for gastric bypass for treatment of obesity and diabetes. Originally, she was told by her insurance company that she needed to have three months of medically supervised weight loss. We were getting ready to submit for pre-approval and found that her company had changed the requirement to six months. The patient was ready and prepared, and the rug was pulled out from underneath her.

She struggled for the next three months but eventually had surgery. Three months later she had lost 80 pounds and no longer was taking medication for diabetes, thereby saving her insurance company thousands in future treatment costs.

There is no evidence to support an insurance-mandated waiting period. I was told that it was to prepare the patient for surgery. I thought that was my job. No other surgery in any specialty has an insurance-mandated waiting period to qualify for surgery.

I turned to an expert in the field, a previous medical director for an insurance company, and asked him about it. He said, “Basically, if the insurance company makes a patient wait three months or even six months, the patient will get tired of waiting and give up.”

Solution: Legislate that obesity is a disease. Treatment should be covered by insurance the same way diabetes or hypertension is covered. Patients should not be excluded from treatment because they are fat. Conversely, we need to treat the fat with proven, evidence-based methods such as weight-loss surgery.

George Baxter of Seattle is a nurse practitioner with a Seattle weight-loss clinic and a doctor of mursing practice candidate at Duke University.