Alabama Bariatrics & Minimally Invasive Surgery

Bariatric Diet Orbera Gastric Band Sleeve Gastrectomy Gastric Bypass

W. Jay Suggs, MD, FACS, FASMBS
Huntsville & Decatur
Phone: (256) 274-4523
Fax: (256) 203-8791

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Contact Us

W. Jay Suggs, MD, FACS, FASMBS
Huntsville & Decatur
Phone: (256) 274-4523
Fax: (256) 203-8791
EMail: drsuggs@alabariatrics.com

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Lawmakers are Taking Notice of Weight Loss Surgery and Healthcare Issues

consulting-lawyer-NZJBCXU copyHuntsville, AL - We have mentioned in the past that insurance companies are often not keen on covering major surgery. They have their own definitions of what they deem treatments as a necessity. Often without understanding the medical context behind how a treatment works. This has led to a lot of patients paying out of pocket for much-needed procedures with money they don't have. Either that or fighting insurance companies every step of the way for the most imperative of medical treatments. Health insurance is just an old issue with many reasons why it needs fixing. You can ask anyone with a need for an expensive medical procedure for a better quality of life. So, what can patients do to be heard? What can they do to get weight loss surgery as part of their much-needed coverage? 

The answer might come from an even bigger policymaker than the ones that decide the cost with the insurance policy. You see, chronic obesity and overweight adults make up over 1/3rd of the American population. What are the chances that some of those Americans are lawyers, or have a role in state or local government? 

Today, we are going to look at just how the legal system is helping with health insurance/ weight loss surgery issues. 

Senators, Governors, Lawyers, and District Representatives are People Too

Given the weight of their position when it comes to the local power structure of an area, it would be easy to mistake politicians as either a caricature of their soundbites or a few people that have the responsibility to wield power. So,  it's hard to contextualize them being regular people that go through regular things. But it is true. Kings die, freak accidents happens to celebrities, and politicians can get sick.  And when they get sick, they have to deal with the discomfort, pain, and health insurance company processes as other people do. That leads to them walking a mile in the public's shoes. 

Eric Berthel,  a 48-year-old Republican state senator of Connecticut, suffered from hypertension, sleep apnea, and joint pain. After undergoing bariatric surgery in 2015, he lost 160 pounds and, he said, those ailments disappeared. According to the Hartford Courant, his major response to this is "championing a bipartisan bill that would require insurers to cover bariatric surgery and similar procedures to treat severe obesity. "This is good medicine and it’s the right thing to do for the people we represent".

But he is not the only one that had gotten the weight loss surgery. Cindy Ressler, a paralegal from the same state tried to get weight loss surgery through her insurance and was surprised to realize how long she had to fight to get them to see it as a medical necessity at all. Initially, her insurance company told her she would have to foot the entire $40,000 bill. It took her and her doctor a year before she could convince them that yes, it was medically necessary. “It took all of 2019. I had to have psych evals, nutritional counseling, a sleep apnea test, colonoscopy, endoscopy, every oscopy you can think of!”

 

Why Aren't Insurance Companies Funding Weight Loss Surgery?

 

There are already 23 states with the demand it is a coverage requirement, but there are those in opposition to the idea. Mainly due to costs and funding. Their main argument is that mandates will drive up the cost of insurance overall. The additional coverage for medical devices could be harder for small businesses to keep up with. But what the opposition and the insurance companies don't often realize is that by tackling the problem of obesity, this creates a decrease in long term costs. Medication for things like sleep apnea, hypertension, diabetes medication, heart surgeries, cholesterol treatments, add up over time. By investing in the procedure, the costs of all these comorbid conditions go down, decreasing the chances of wasted financial investment by getting to the root of the problem.  

 

Because insurance companies and most people do not realize that obesity is a condition that has little to do with will power. It is a combination of microbes in your gut, excess hormones, and other metabolic complications. While there are certainly a few environmental factors and bad choices to blame, the responsibility of the condition doesn't all lie on one person or their lifestyle. 

 

Conclusion

We might be headed in a more positive direction with the country overall. This is thanks to the increased awareness of what weight loss surgery is. Maybe the effects will be so far-reaching that politicians in Huntsville, Al will be willing to include this as part of their coverage. We just got to be vocal and let the issue hit them at home and their own wallets. 

www.alabariatrics.com