Obesity Discussion Forums - View Single Post - Insurance coverage for obesity surgery being sought in St. Lucie

Obesity Discussion · 02-18-07, 07:55 PM

Insurance coverage for obesity surgery being sought in St. Lucie

SARAH GRILE sarah.grile@scripps.com

Gene Reynolds, a teacher at Port St. Lucie Elementary, prepares to give himself an injection Wednesday as his niece, Katie Collins, 6, watches at his home in Port St. Lucie. Reynolds wants to get gastric bypass surgery because of his obesity, but the school district health insurance does not cover the $18,000 to $20,000 procedure.

By MARGOT SUSCA
margot.susca@scripps.com
February 18, 2007

PORT ST. LUCIE — Gene Reynolds pulled his T-shirt up and over his bulging belly, inserting two needles into his mass of flesh.
When Reynolds removed the needles after 90 minutes, his 17-year-old son Jared quickly rose from the couch to retrieve an alcohol pad from a Styrofoam cooler in the dining room to stop the bleeding.
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"Unless something changes, he'll be dead before he's 50," Jared said. "That really scares me."
Reynolds is among an estimated 18 million Americans struggling with morbid obesity and fighting to convince health care providers to pay for the expensive and controversial surgery commonly known as "stomach stapling," which he and other advocates say could save countless lives and dramatically reduce future medical bills.
The decision over whether to cover the surgery, which is being weighed in board rooms and municipalities across the country, will be considered next by the St. Lucie County School District, where Reynolds is a Port St. Lucie Elementary music teacher.
"If, in the future, data is available to clearly demonstrate that gastric bypass surgery is safe, effective and necessary, then the committee will certainly reconsider coverage," district Chief Financial Officer Tim Bargeron wrote in January 2006, after the school district insurance committee denied a similar request to add the surgery to their health plan, one month before Medicare began covering it.
The operation recently received national media attention when University of Notre Dame football coach Charlie Weis filed a medical malpractice lawsuit, saying he bled internally for 30 hours in 2002 after his surgery.
Opponents say the surgery, which includes shrinking the stomach using staples or a plastic band, can result in infection, ulcers, lung blood clots or death.
"As with any major abdominal surgery there are risks directly associated with gastric bypass," according to a report from the Virginia Commonwealth University Medical Center. "Although measures are taken to reduce the risks of these complications, they are sometimes unavoidable."
Advocates, however, say the operation is becoming safer and it can prevent costs associated with morbid obesity, such as diabetes, heart failure and sleep apnea, which is a condition where the soft tissue in throat collapses and restricts breathing while sleeping.
Philip Schauer, a Cleveland Clinic gastric bypass surgeon and head of the American Society for Bariatric Surgery, estimated that insurance covers about 1 percent of people who qualify for the bypass procedure — primarily for those at least 100 pounds overweight.
"Not only does it improve patients' quality of life but it extends their life," Schauer said. "Obesity is a potentially lethal disease and insurance companies don't have a strong argument in not covering this."
Reynolds, 47, stands 5-foot-10 and weighs 350 pounds. He says he is responsible for his weight problem but respiratory problems make losing weight through exercise a challenge.
In his early 30s, the father of two, who used to enjoy golfing and working out, weighed 200 pounds. By age 40, he tipped the scales at 280. Now, he weighs more than twice as much as he should, according to the National Heart, Lung and Blood Institute.
Reynolds has visited several physicians about the surgery and some consider him, and his 56-inch waist, a perfect candidate for the procedure.
"We have recommended that you participate in an aggressive weight reduction program and be evaluated for bariatric surgery," reads a 2006 letter Reynolds received from the Mayo Clinic in Jacksonville. "It is unlikely you will achieve the necessary weight loss with diet and exercise alone."
Last year alone, Reynolds paid $5,500 in out-of-pocket costs for medical expenses.
He says the school district has been forced to pay thousands of dollars in recent years on substitute teachers to cover his constant sick days due to adverse reactions to medications that require he inject himself with two needles in his thighs and two more into his stomach twice a week.
Reynolds said the 14 medications he takes daily can prolong his possible death only for so long. For the man who gets winded walking 20 feet from his front door to the family van, a stomach-stapling surgery is a risk he's willing to take.
"I don't think I'm going to be alive a whole lot longer if I don't get it," he said. "I'm not taking this lightly. This is something you do when it's life-threatening."
• Each year, the obesity epidemic costs nation more than $117 billion in medical costs and lost productivity.
• Employers lost an estimate $3.9 billion in productivity due to obesity among Americans age 17 to 64.
• Obese men and woman between the ages of 30 to 50 spend 36 percent more on health care services and 77 percent more on medications than cigarette smokers.
About gastric bypass surgery
• Costs between $20,000 and $25,000
• Improved life expectancy by 89 percent
• In 2006, an estimated 177,600 people with morbid obesity in the U.S. had bariatric surgery. American Society for Bariatric Surgery

Obesity Surgery

02-18-07, 07:55 PM	#1 (permalink)
Obesity Discussion Administrator Join Date: Jan 2005 Location: Phoenix, AZ Posts: 7,955 Weight Statistics 8/1/2006 Start Date: 185 lb Start Weight: 152 lb Current Weight: 155 lb Goal Weight: -33 lb Weight Loss: 5/1/2007 Goal Date:	Insurance coverage for obesity surgery being sought in St. Lucie Insurance coverage for obesity surgery being sought in St. Lucie SARAH GRILE sarah.grile@scripps.com Gene Reynolds, a teacher at Port St. Lucie Elementary, prepares to give himself an injection Wednesday as his niece, Katie Collins, 6, watches at his home in Port St. Lucie. Reynolds wants to get gastric bypass surgery because of his obesity, but the school district health insurance does not cover the $18,000 to $20,000 procedure. By MARGOT SUSCA margot.susca@scripps.com February 18, 2007 PORT ST. LUCIE — Gene Reynolds pulled his T-shirt up and over his bulging belly, inserting two needles into his mass of flesh. When Reynolds removed the needles after 90 minutes, his 17-year-old son Jared quickly rose from the couch to retrieve an alcohol pad from a Styrofoam cooler in the dining room to stop the bleeding. Advertisement "Unless something changes, he'll be dead before he's 50," Jared said. "That really scares me." Reynolds is among an estimated 18 million Americans struggling with morbid obesity and fighting to convince health care providers to pay for the expensive and controversial surgery commonly known as "stomach stapling," which he and other advocates say could save countless lives and dramatically reduce future medical bills. The decision over whether to cover the surgery, which is being weighed in board rooms and municipalities across the country, will be considered next by the St. Lucie County School District, where Reynolds is a Port St. Lucie Elementary music teacher. "If, in the future, data is available to clearly demonstrate that gastric bypass surgery is safe, effective and necessary, then the committee will certainly reconsider coverage," district Chief Financial Officer Tim Bargeron wrote in January 2006, after the school district insurance committee denied a similar request to add the surgery to their health plan, one month before Medicare began covering it. The operation recently received national media attention when University of Notre Dame football coach Charlie Weis filed a medical malpractice lawsuit, saying he bled internally for 30 hours in 2002 after his surgery. Opponents say the surgery, which includes shrinking the stomach using staples or a plastic band, can result in infection, ulcers, lung blood clots or death. "As with any major abdominal surgery there are risks directly associated with gastric bypass," according to a report from the Virginia Commonwealth University Medical Center. "Although measures are taken to reduce the risks of these complications, they are sometimes unavoidable." Advocates, however, say the operation is becoming safer and it can prevent costs associated with morbid obesity, such as diabetes, heart failure and sleep apnea, which is a condition where the soft tissue in throat collapses and restricts breathing while sleeping. Philip Schauer, a Cleveland Clinic gastric bypass surgeon and head of the American Society for Bariatric Surgery, estimated that insurance covers about 1 percent of people who qualify for the bypass procedure — primarily for those at least 100 pounds overweight. "Not only does it improve patients' quality of life but it extends their life," Schauer said. "Obesity is a potentially lethal disease and insurance companies don't have a strong argument in not covering this." Reynolds, 47, stands 5-foot-10 and weighs 350 pounds. He says he is responsible for his weight problem but respiratory problems make losing weight through exercise a challenge. In his early 30s, the father of two, who used to enjoy golfing and working out, weighed 200 pounds. By age 40, he tipped the scales at 280. Now, he weighs more than twice as much as he should, according to the National Heart, Lung and Blood Institute. Reynolds has visited several physicians about the surgery and some consider him, and his 56-inch waist, a perfect candidate for the procedure. "We have recommended that you participate in an aggressive weight reduction program and be evaluated for bariatric surgery," reads a 2006 letter Reynolds received from the Mayo Clinic in Jacksonville. "It is unlikely you will achieve the necessary weight loss with diet and exercise alone." Last year alone, Reynolds paid $5,500 in out-of-pocket costs for medical expenses. He says the school district has been forced to pay thousands of dollars in recent years on substitute teachers to cover his constant sick days due to adverse reactions to medications that require he inject himself with two needles in his thighs and two more into his stomach twice a week. Reynolds said the 14 medications he takes daily can prolong his possible death only for so long. For the man who gets winded walking 20 feet from his front door to the family van, a stomach-stapling surgery is a risk he's willing to take. "I don't think I'm going to be alive a whole lot longer if I don't get it," he said. "I'm not taking this lightly. This is something you do when it's life-threatening." • Each year, the obesity epidemic costs nation more than $117 billion in medical costs and lost productivity. • Employers lost an estimate $3.9 billion in productivity due to obesity among Americans age 17 to 64. • Obese men and woman between the ages of 30 to 50 spend 36 percent more on health care services and 77 percent more on medications than cigarette smokers. About gastric bypass surgery • Costs between $20,000 and $25,000 • Improved life expectancy by 89 percent • In 2006, an estimated 177,600 people with morbid obesity in the U.S. had bariatric surgery. American Society for Bariatric Surgery Obesity Surgery __________________