by Patrick Appel
A reader writes:
With all due respect to the reader who related the story about her father’s delayed gastric bypass operation, I have to inject some qualifiers into the situation. First, I am speaking as someone who recently received insurance company approval for the lap-band procedure, which is a similar, although less invasive, form of gastric surgery. My operation is in two weeks, and I was pleasantly surprised when my insurer (I have a policy via my employer, which is a small group) rather quickly approved the pre-qualification request from the surgeon, and even set me up with a case manager for counseling and nutrition information. I will have some significant out of pocket expenses, but I calculate that I will recoup that cost in what I save on medications over the ensuing year or so.
Ten years ago, gastric surgery was considered quite exotic, and had only recently made it past the experimental stage and been FDA approved for the general public.
It was also open abdominal surgery, as opposed to the current lap-band procedure, which is done laparoscopically, so it had an unusually high complication rate. My brother had it done nine years ago, and complications put him in the ICU for five days; I knew two acquaintances who had complications about that time and died as a result. So it was a very costly and very problematic surgery back then. Thankfully, there have been a lot of advances since then---otherwise, I would never consider it for myself.
At the same time, science has learned more about obesity and its causes, and what they have learned has only reinforced the understanding that gastric surgery is an effective way to deal with obesity and its many side-effects, such as those the reader’s father had. While switching to Medicare probably played a role in the ease of getting the surgery approved this time out, the passage of time, which has proven the efficacy of the surgery and improved its safety, surely played a role. In short, while I am certainly no apologist for health insurers, I think they deserve somewhat of a break on this one.