Medicare and Medicaid coverage of Bariatric Surgery

Do the overall benefits of bariatric surgery justify the medical risks and financial costs involved? Should more people be getting it or should we tighten the restrictions on who is a worthy candidate? Both private and federal insurance need to answer these questions as bariatric surgery grows in popularity.

Private insurance companies are the ones paying the bill for this $25,000-$50,000 surgery, but only when it has been proven that no other method of treatment has worked for weight loss. They require documentation that patients have tried and failed at changes in exercise and diet from their primary care physician.

Restricting Medicare and Medicaid Coverage

On the other hand, the Federal Center for Medicare & Medicaid Services is rewriting the guidelines for candidcy as well as if Medicare and Medicaid should be covering bariatric surgery in the first place. Some experts in the field are urging the CMS to lower age restrictions on the surgery and make it more available to others. Currently, Medicare and Medicaid require that co-morbidity exists in a patient, such as diabetes or high blood pressure, due to the excessive weight. Medicare and Medicaid do not cover some variatrions of bariatric surgery. Also, the coverage is available only to seniors under the age of 65. Some doctors claim that obesity is the “last politically correct discrimination.” The current policy is very strict in deciding who is covered when compared to private insurance. Should taxpayers have to foot the bill for gastric bypass and other surgeries? If Medicare and Medicaid pay for lung cancer in smokers, is it not the same qualification? An addiction to something causes illness and disease, so why should something like treating cancer be covered but obese people are left without coverage? These questions have to be answered as obesity is on the rise in America. It has surpassed tobacco as the number one cause of disease in America, and it costs employers over $100 billion dollars a year. Many bariatric surgeons say we should not look at the cost involved, but the proof that bariatric surguer is a life-saving treatment when all else has failed.

It will take some years before morbidly obese people are given fair treatment, especially those who cannot afford the surgery. Many, if not all, physicians and surgeons agree that obesity shortens the lifespan. Hopefully the Center for Medicare & Medicaid will understand and agree by beginning to losen the qualifications for coverage.

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