By Phil Galewitz, The Palm Beach Post, Fla. Knight Ridder/Tribune Business News
Feb. 13--Seeking to put its hefty costs on a diet, Blue Cross and Blue Shield of Florida is eliminating coverage of gastric bypass surgery, the popular weight-loss surgery made famous by NBC weatherman Al Roker.
The change, which the state's largest insurer announced Thursday, will take effect at the beginning of 2005.
The surgery costs too much and has too many complications, Blue Cross said. Last year, the Jacksonville-based company covered the procedure for 1,000 Floridians at a total cost of nearly $20 million. Although that figure is a smidgen of the company's more than $2 billion in annual health revenue, company officials were worried the number of customers seeking the procedure would continue to double each year.
'Gastric bypass surgery is an extremely risky procedure that is of questionable benefit to the patient,' said Dr. Robert Forster, Blue Cross' vice president and chief medical director. 'We are concerned at the growing numbers of these procedures while significant questions remain regarding quality of care, safety and long-term consequences.'
Gastric bypass typically costs from $20,000 to $35,000. Several Palm Beach County hospitals, including JFK Medical Center in Atlantis, Boca Raton Community Hospital and Delray and Jupiter medical centers perform the procedure.
During the past two years, the number of Americans seeking weight-loss surgery has skyrocketed, mirroring an epidemic rise in obesity. According to the American Society for Bariatric Surgery, 103,000 Americans, mostly women, underwent obesity surgery in 2003, compared with 63,100 in 2002 and 40,000 in 2001.
Dr. Jefferson Vaughan, a gastric bypass surgeon at Jupiter Medical Center, said he was disappointed with Blue Cross' decision but not surprised. Insurers are more interested in their short-term financial interests than helping patients over the long term, he said.
'It's a sad day but the insurers have their own bottom line to worry about,' he said.
Without insurance coverage, many patients will forego the procedure, he said.
Blue Cross is not the first major insurer in Florida to end the coverage. United Healthcare, Humana and Cigna have stopped covering the procedure. Aetna, however, still covers it.
Most insurers that cover the surgery also require that patients be morbidly obese, with their weight endangering their lives through a link to high blood pressure, diabetes, kidney disease or other problems.
The National Institutes of Health recommends reserving the surgery for patients with body-mass indexes above 40. That is about 100 pounds overweight for men and 80 pounds overweight for women.
Deaths of gastric bypass surgery patients at several U.S. hospitals last year have caused some leading institutions to shut down their obesity surgery efforts.
Despite these cases, the enormous amount of positive media coverage and word-of-mouth recommendations about weight-loss surgery has fueled interest in the procedure. Several members of Congress, singer Carnie Wilson and Roker have undergone successful gastric bypass surgery.
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(c) 2004, The Palm Beach Post, Fla. Distributed by Knight Ridder/Tribune Business News.
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