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Obesity Healthcare Costs US 147 Billion Dollars A Year, New Study

The annual healthcare cost of obesity in the US has doubled in less than a decade and may be as high as 147 billion dollars a year says new government-sponsored research.

  • In 1998 the medical costs of obesity in the US were estimated at around 78.5 billion dollars a year, half of which was financed by Medicare and Medicaid.
  • Between 1998 and 2006, the prevalence of obesity in the US went up by 37 per cent.
  • This rise in obesity prevalence added 40 billion dollars to the annual healthcare bill for obesity.
  • The annual healthcare costs of obesity could be as high as 147 billion dollars for 2008.
  • Obesity is now responsible for 9.1 per cent of annual medical costs compared with 6.5 per cent in 1998.
  • The medical costs for an obese person are 42 per cent higher than for a person of normal weight.
  • This equates to an additional 1,429 dollars per year: the costs for an obese person on Medicare are even greater.
  • Much of the additional Medicare cost for an obese person are the result of the added prescription drug benefit.
  • Medicare prescription drug payments for obese recipients are about 600 dollars a year more than for normal weight recipients.
  • Obesity accounts for 8.5 per cet of Medicare expenditure, 11.8 per cent of Medicaid expenditure, and 12.9 per cent of private insurance expenditure.

"As a result, the medical costs attributable to obesity are almost entirely a result of costs generated from treating the diseases that obesity promotes," he added, suggesting that as long as obesity prevails to the extent that it does today, it will continue to be a significant burden on health care."

The study was conducted by researchers at RTI International, the Agency for Healthcare Research and Quality, and the US Centers for Disease Control and Prevention (CDC) and is published in the 27 July issue of the health policy journalHealth Affairs.

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Don't put it off any longer! Find out if your insurance will cover weight loss surgery today!

Weight Loss Surgery Insurance / Finance Introduction

Whether you have insurance, Medicare or are paying yourself, the money and effort you expend on weight loss treatments can provide a significant payback in the form of an improved quality of life. People with a real weight problem who achieve long-term weight loss experience many health improvements.

So don’t let the cost of weight loss surgery keep you from getting the help you need. There are options available for people in many different financial situations. Remember, we are very knowledgeable about the payment options, so be sure to contact us.

What are my options for covering the costs of weight loss surgery?

INSURANCE: Many insurance companies will provide coverage for weight loss surgery if it is considered a medical necessity and the patient meets the National Institute of Health (NIH) requirements for bariatric surgery. The costs depends upon the type of policy and its terms, as well as any contractual arrangement with the hospital.  Insurance coverages come in many types, and coverages really cannot be predicted, since they vary from policy to policy, even when issued by the same insurance company. If you wish to contact us for evaluation and surgery, we perform the insurance authorization and approval process without charge.  With specific policy information and approval, we can obtain your out-of-pocket expected costs before you schedule surgery. Learn more about getting approved by your insurance company for weight loss surgery.

CASH / FINANCE: Many patients choose to pay for the operation themselves. We offer special packages for cash patients, which include all usual services, at a substantial discount.  The actual rate varies, depending on the type of surgery chosen, and initial weight and health status. Contact us to learn more about paying cash or financing your weight loss surgery.

Payments: We accept cash (wire transfer only), personal checks, money orders, cashier checks, VISA, MASTERCARD, and AMERICAN EXPRESS. For those interested in extended payment plans, we have an excellent outside healthcare finance service: CareCredit

Insurance Coverage of Weight Loss Surgery

Our offices participate with many Insurances, and PPO´s. Please understand that you are fully responsible for all treatments rendered, which includes services payable by your insurance company as determined by your employer.

About Insurance:

You might be surprised to learn that many insurance companies will cover the treatment of health problems caused by obesity but not obesity itself or that a conclusion that a particular service is medically necessary does not constitute a warranty that treatment is covered (i.e., will be paid for by your insurance) for a particular member. So it is a good idea to have a basic understanding of what your insurance will cover prior to setting up a meeting with a bariatric surgeon.

In general, insurance companies require a Body Mass Index (BMI) of 40 or higher. A BMI of 35+ may be allowed depending on the number and severity of the patient's related comorbidities. The National Institutes of Health (NIH), a division of the US Department of Health and Human Services, has set patient criteria for weight loss surgery which states that eligible patients should have a BMI of 40 or higher (morbidly obese) or a BMI of at least 35 with co-morbidities (obesity related health conditions) such as diabetes, sleep apnea, heart disease, high cholesterol, or hypertension (high blood pressure). Eligible patients must also have attempted and failed at previous weight loss efforts and need to pass a psychiatric evaluation to be recommended for weight loss surgery. To obtain an approval for surgery through your insurance company, you may need to complete certain tests and evaluations. Once you complete your health questionnaire, our office will help you to complete the items your insurance company requires.

Remember, surgery is a last resort treatment meaning you have tried and failed to change any one or combination of the following factors/treatments:
  • environmental/behavioral (dietary, physical exercise)
  • biological (pharmacological)

 

Where do I start?

To get preapproved you will need to provide us your insurance and health information and we will contact your insurance company and determine whether you are covered for weight loss surgery. If you are covered, we will set up an appointment where we will discuss the risks and benefits, procedures and how your body will be changed, and the necessary lifestyle changes associated with weight loss surgery.

As you may have noticed above, the need for surgery, and the coverage by insurance, usually depends upon the determination that surgery is medically necessary to improve health, to reduce risks to life, and to permit a normal lifestyle. It also depends upon the determination of the person seeking care, in developing the arguments for surgical treatment, and in accumulating corroborating information, and physician opinions, to substantiate the medical necessity.

If the doctor initially believes that you could be a candidate, additional tests may be necessary to support and validate your need for surgery. Once the surgeon has concluded that you are a candidate for surgery, he/she will notify your insurance company, submitting a letter of medical necessitiy requesting authorization for surgery based on your medical conditions that would most likely improve with bariatric surgery.

Generally, most institutions will require you to also see the various specialists for pre-operative clearance. Your surgeon or primary care physician can refer you.

In the end, all of this preparation could go to waste if you are not ready to make this life long - life style change. Like an investment, your surgical weight loss institution will be investing a lot of time and effort and you will be investing in your life. So, the assessment of your motivation is a prerequisite for weight loss therapy. For these reasons, motivation for weight loss should be high before initiating your plan of action and usually your doctors will be very conservative in their evaluations. They will assess your attitude and reasons to gage your motivation and seriousness, they will inquire about your outside support team and your environment, they will insure that you have educated yourself and understand your obesity and its associated risks, and will attempt to gain an understanding as to the reasons any previous attempts at weight loss or maintenance of normal body weight failed or succeeded and will explain how this treatment plan will be different. And lastly, the financial considerations such as having to pay for travel to the medical facility, time lost from work, and paying for professional counseling that is not covered by insurance.

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Your practitioners office will usually contact your insurance company often to get a status report. It can take as long as a month and a half to hear from your insurance company. Once surgery is approved, you may get a letter directly from your insurance, if not our office will call to notify you.

Usually after the insurance authorization is confirmed, you will usually be seen again by your surgeon. This time a physical examination will be performed and you may be scheduled for additional tests. You may also be asked to complete a questionnaire related to bariatric surgery and to sign a disclosure statement regarding operative risks and blood transfusions. You will probably be scheduled for a pre-operative seminar. This seminar is designed to give you an overview of your hospital experience, and give you specific information about pre-operative and post-operative hospital procedures.

Financial and Insurance Issues
The average time in the hospital is 2 days for laparoscopic, gastric bypass, and 1 day or less for gastric banding depending on your particular surgery. Recovery time is about 2 to 6 weeks depending on the type of operation, your condition, the type of work that you do, and other factors.

The cost of the operation can include:
  • Hospital fees
  • Surgeon fees
  • Anesthesia fees
  • Lab and x-ray fees
  • Miscellaneous fees
Many insurance companies will cover the full cost of bariatric surgery. We will need to document for them that your bariatric surgery is a medically necessary procedure done because of specific health concerns. We may also need to provide specific documentation depending on your policy to show that:
  • You have tried and failed other non-surgical weight loss methods
  • You have undergone nutritional counseling
  • You do not have major psychiatric or emotional problems that would make surgery unsafe
We can usually help you to meet many of these requirements. Some insurance companies have specific language in their policy that excludes payment for bariatric surgery. Unfortunately most of the large Health Maintenance Organizations (HMOs) fall into this category. Other health insurance organizations such as Kaiser do not cover any expenses outside of Kaiser facilities.

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If you have such a policy, or your plan does NOT cover "out of network" physicians, or does not approve you for surgery, or if you are uninsured, you may want to consider financing the surgery. Many patients choose to pay for the operation themselves. We can arrange for you to meet with a financial specialist who will give you a price quote for the whole package (Pre-operative, operative, and post-operative care). Payment by Visa and MasterCard is also accepted.

Things You Can Do To Help Yourself
These are some of the things that you can do prior to your first visit to help things run more smoothly:
  • Know your insurance company
  • Read your policy
  • Call your representative
  • Bring in your insurance card with policy# and address


Gather your medical records
Medical records that document any co-morbid conditions (diabetes, sleep apnea, hypertension, hyperlipidemia (high cholesterol), heart disease, acid reflux, arthritis, etc. Document medically supervised weight loss attempts (Jenny Craig, Weight Watchers).

Keep a dietary log
Keep track of every single thing that you eat or drink for 2 weeks prior to your initial consultation visit.

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Finally, it is important to note that while we do try to anticipate the needs of the various insurance companies, pre-authorization can never be guaranteed nor is it a guarantee of payment in full. However, are fully committed to working with you, your physicians and your insurance company to ensure success in every aspect of attaining your weight loss goals.

Self Pay - Cash and or Financing for Weight Loss Surgery

Healthcare Finance:

If your plan does not cover the cost of surgery and ongoing care, or pays for only part of the cost, you may choose to arrange financing; what better investment is there than putting your money to work protecting your health and well-being? Also, there can be tax advantages to personally paying for your treatment. The Internal Revenue Service allows you to deduct the amount of any medical expenses that are more than 7.5 percent of your adjusted gross income. The deduction applies to you, your spouse and any dependents in your family. Check with your accountant to find out exactly what portion of your expenses is deductible.

Healthcare Finance makes it easy to afford the reconstructive or cosmetic surgery that you need or want. Use them to pay for procedures, from $1,500 to $25,000.

You can even pre-approve your financing over the phone prior to your consultation, so that you may determine where you stand financially. These are just a few of the many benefits you may take advantage of. Contact us for more information on financial options, and determine what is the best step for you.

CareCredit is a flexible patient/client payment program, specifically designed for healthcare expenses, which make it easier for you to get the treatment or procedures you want and need. CareCredit is ideal for co-payments, deductibles, treatment and procedures not covered by insurance, and can be used at over 35,000 practices nationwide. CareCredit, a GE Money company, has helped more than 7 million patients get the care they want and need.

CareCredit offers a full range of payment plans. Their 3, 6, 12, & 18 month No Interest payment plans feature monthly payments as low as 3% of the balance and let you pay within the specified time without incurring interest charges. Simply make your minimum monthly payment and pay off your entire balance during the agreed upon time period, and you'll pay no interest.

For patients with higher treatment fees who would prefer more time to pay with lower monthly payments, their 24, 36, 48, & 60 month extended payment plans* offer a low, fixed 13.9% interest rate and an extended term.

Remember, we are very knowledgeable about the payment options, so be sure to contact us.

Insurance Related News:

 

Health insurers backing off obesity surgeries

By Christopher Snowbeck, Pittsburgh Post-Gazette

Health insurers, seeking to control overall costs, are trying to tip the financial scales by dropping coverage for popular but expensive obesity surgeries.

The moves respond to the increased use of gastric bypass procedures, which have been championed by celebrities and could swell the overall number of obesity surgeries in the country this year to 200,000. At a cost of about $25,000 each in simple cases -- and much more in complicated ones -- health plans say the costs have driven up premiums so much that their customers just can't afford it.

"Many employers are finding it difficult to provide health insurance at all these days," said Susan Pisano, spokeswoman for America's Health Insurance Plans, the trade group for health insurers. "What they see in gastric bypass surgery is a procedure that's being overused, and that's driving their health care costs up, so they face a dilemma."

But doctors counter that there is no overuse, just a growing recognition of the surgery's benefit. They say the procedures are clearly necessary for some morbidly obese patients, for whom dieting isn't a solution.

"If you speak to the world experts on the best available behavioral, diet and lifestyle interventions, they will tell you they are not successful long-term for people who have more than 100 pounds to lose," said Dr. Anita P. Courcoulas, director of bariatric surgery at the University of Pittsburgh Medical Center. "There's good data out there that shows for 60 percent to 80 percent of patients who have this surgery, their long-term health is markedly improved."

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A 2004 report from the Pennsylvania Health Care Cost Containment Council found that 6,791 gastric bypass surgeries were performed in the state in 2003, up ten-fold from 1999 when only 674 were performed. Between 1999 and 2003, the number of surgeons performing gastric bypass surgery increased from 31 to 84, the council reported, and the number of facilities increased from 26 to 49.

In the face of the increase, HealthAmerica has decided that, effective June 1, groups renewing their health benefits with the insurer no longer will receive obesity surgery coverage in their basic medical plan. Firms with more than 250 employees can obtain coverage if they purchase a rider for obesity surgery.

HealthAmerica's move follows similar steps taken by national insurers Aetna and Cigna.

Locally, Highmark and UPMC Health Plan continue to include gastric bypass surgery in basic health insurance coverage. But the number of surgeries covered by Highmark dropped during 2004 after the insurer tightened the criteria for patients seeking operations.

Robert L. Dawson, HealthAmerica's president and chief executive officer, said the company believes the surgery is "an extraordinary risk to take," particularly if patients don't also address the underlying diet and lifestyle issues involved with obesity.

But cost is a factor, too. "Coverage for obesity surgery benefits a small number of people at a cost that is incurred by all our members and their employers," a March 15 letter from HealthAmerica explaining the change said.But many of those patients who need the procedure will struggle to pay for it out-of-pocket, said Dr. Nilesh Patel, a bariatric surgeon at Allegheny General Hospital. Obesity is a socially acceptable prejudice, Patel said, and society has no sympathy for fat people, saying it is a self-inflicted problem.

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Courcoulas, the UPMC surgeon, said the risks of illness and death following obesity surgeries are no greater than with any other complex abdominal operations. While there are significant up-front costs with the procedures, Courcoulas argued that health plans would recoup their investments in about three years as post-surgery patients avoid other health problems.

Some insurers, including Highmark, now require supervised diet therapy prior to surgery. Dr. Martin Fenster, Highmark's medical director for utilization management, said he agreed that dieting along isn't a long-term solution for many patients. Even so, patients after surgery must make lifestyle changes so they don't regain the weight, Fenster said, and might as well develop the habits beforehand.

Highmark's restrictions drastically cut the number of covered surgeries from more than 3,000 in 2003 to less than 2,000 in 2004. Even so, the rate of surgeries in the region still exceeds the national average, Fenster said.

Some of the quality problems have simply been a function of surgeons learning how to do gastric bypass surgeries laparoscopically. Gastric bypass surgeries performed through large, open incisions have been around since the 1960s, but were never as popular.

"You have a lot of doctors on the learning curve, and everybody wants to get in on the learning curve," Fenster said.

If all the recent news about insurers clamping down on obesity surgery is casting a pall on this week's annual meeting of the American Society of Bariatric Surgery, Barbara Thompson hasn't noticed. The Upper St. Clair resident, who underwent obesity surgery more than 5 years ago and sings its praises, is attending the meeting in Orlando, Fla.

"I'm optimistic," Thompson said, noting that Medicare was asked this year to consider expanding coverage of gastric bypass to patients who are just obese -- as opposed to those who have certain related health problems.

"The surgery just gives you tremendous freedom," said Thompson, who has published books on the subject. "It's improved my health, my life, my self-esteem, my ability to live life fully."