The Flowered Barrier

Health Plans Harming Health for People with Obesity

It’s that time of year. Many people are picking health plans. For folks who get health insurance through their employer, that might mean looking through confusing options to pick the one that best suits their needs. For others with Medicare, that might mean choosing between insurance options that provide better coverage than bare bones Medicare. But for everyone involved, it means buyer beware. Because especially for people with obesity, many health plans have provisions that can wind up harming their health.

A new study shows precisely how this works to the detriment of people who need bariatric surgery. Hamlet Gasoyan and colleagues from Temple University show that some health plans have found ways to make people give up on seeking surgery. In fact, by putting a three to six month delay into the process for bariatric surgery, some health plans assure that more than half of the people who need it will simply give up.

Never mind that this is a procedure that helps people live longer, healthier lives.

Stealthy Denial of Care

Outright denying bariatric surgery has become difficult. That’s because the benefits for people who need it has become so clear. For people with any degree of obesity and type 2 diabetes, it offers by far the best odds for putting diabetes into remission. It does a better job of protecting kidney function in patients with diabetes and kidney disease, too. Risk from heart disease is lower, likewise for certain kinds of cancer. The list of benefits is long.

So most private health plans now say they’ll cover bariatric surgery. But some of them have other ways of keeping people from getting the care they need. And that’s what Gasoyan et al showed. They examined health and insurance records for 1,054 patients who either had surgery or who met the medical criteria for surgery but did not have it. They found that the odds of having surgery went down by 54 percent if a person’s health plan made them wait through three to six months of a medical weight loss plan after surgery was indicated.

On a side note, it also looks like HMOs are better at discouraging people from getting surgery than PPOs or fee-for-service health plans. Patients who qualify for needing bariatric surgery were about 30 percent less likely to get it in an HMO.

Only Profits Benefit

Because of prevailing bias about obesity and the people who live with it, making folks wait six months is easy to rationalize. Why not? Maybe they’ll lose some weight.

But the truth is that there’s no medical reason for making people delay this life saving procedure. Outcomes don’t improve. Complications of obesity progress and damage the body while the patient waits. But for the health plan, it certainly delays an expense for the surgery. Even better for their profits, it seems that it discourages up to half of the people who need surgery from getting it.

Yes, bias makes it easy to rationalize this way of doing business for some health plans. But it doesn’t make it right.

Click here for the study by Gasoyan et al.

The Flowered Barrier, painting by Paul Serusier / WikiArt

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October 28, 2020