WLS Related Insurance changes for 2006

The place I work is changing insurance requirements related to weight loss surgery. Next year, they will not approve any lapband surgeries. They are going to require: 2 years BMI 40+ with sleep apnea, diabetes, hypertension, or immobility secondary to joint pain that is not responsive to medical treatment 2 years participation in a work related wellness/health program Pre & Post surgery Life Coaching Participation in an after care program $4000.00 facility charge in addition to normal deductibles and does not count toward other out of pocket expenses The added cost and time that is going to be required for others going forward is disheartening! According to these new guidelines I wouldn't have qualified for surgery. I had a BMI of 40+ but I didn't have any other co-morbidities. THANK goodness I had surgery when I did, my approval process was painless and I got approved within a month of my submission. I was so lucky. Now, I'm 16 months post surgery now and had a steady uneventful recovery. I've lost 90% of my excess weight and feeling better than I have for 10 years! My heart aches for those who will have to go through this now. Regina

I'm 2+ years out. I met the new president of my company and WLS came up. He said that among executives, WLS is getting a bad reputation as being both costly and inneffective, with regain being all too common. I agree with you about feeling very fortunate that I crept through the window when I did. Unfortunately, all too many people who have WLS qualify on paper yet are simply candidates for failure. It takes more to make this work than just meeting the BMI guidelines. I expect this to get worse. Nowhere Man/PH/Jay

It is really sad and frustrating to see that it is getting more and more difficult to get weight loss surgery. I wouldn't have qualified by these standards either. I don't think it is fair to blame the people wanting the surgery, although I do see some problems there, I feel the problem lays with programs not providing enough pre and post operative support. It is my understanding that was the theory behind the whole "centers of excellence" thing. I still believe that this surgery is a medically accepted treatment for morbid obesity and insurance companies should be required to cover such treatments. I don't believe it is fair to leave these decisions up to the business executives as it is a medical problem that most lay people don't understand. I REALLY don't understand the Lap-band exclusion as I believe it may be the future of wls. Unless they are afraid too many people are choosin git because it has less risk. Our medical insurance system stinks!

My personal opinion here: everything I read that is evidence based shows a lower weight loss with the band and a higher chance of regain. Also many band people are getting revisions to another WLS. I think the exclusion is just a way of saying go for the treatment with the highest rate of effectiveness first rather than paying for 2 different procedures. I do not mean this as an insult or anything to those who have the bands and are successful, just that this is what the statistics say.

That is not at all what the statistics I have read say. If they wanted the procedure withthe highest rate of effectiveness then maybe they should be supporting the DS.

I realize that insurance companies provide coverage according to the package the company "buys". So the insurance company isn't completely the fall guy here. And, I would have guessed with growth of using wls as a treatment for obesity and the overall cost involved -- that regulations would change for approval processes. It doesn't make me feel any better about it though! It makes me feel like the workplace and insurance companies are basically practicing medicine -- by taking these decisions out of the doctors' (and patients') hands and by putting these requirements on prescribing the treatment. I also think - in many cases - this surgery is (and should be) considered as a PREVENTATIVE and proactive measure to be taken BEFORE comorbidities affect a person's quality of life. But no, now pts will have to suffer a lower quality of life for at least 2 years before surgical intervention will be allowed. I've read of so many people having to jump through hoops to get approved, and this just tells me it's going to be getting worse, rather than better. AND that's just this year's requirements. I can't even begin to guess what it will be next year!