Weight Loss Surgery Not Covered By Most Health Insurance Plans

Patricia Didelot

Weight loss surgery is not covered by most health insurance plans and so about 78 millions of Americans are left out wondering how they can afford to follow their doctor's advice.

For those that need weight loss surgery -- on the advice of their physicians -- things don't look promising, as the financial cost is almost impossible to afford for the majority of Americans.

MaryJane Harrison's health insurance plan -- provided by UnitedHealth -- does not cover the surgery three different doctors have recommended.

"I am now 53 and I don't think I'm going to live to be 55," says Harrison, from the San Antonio area and has failed to lose weight through diet and exercise. "When you feel your health deteriorating this fast, you know it."

Harrison is now trying to raise the $15,000 the stomach-shrinking surgery is expected to cost her and likely save her life.

The 53-year-old case highlights the fact that while the obesity crisis hits record levels in the US, weight loss surgery has stayed at the same levels for a decade.

UnitedHealth would not comment on Harrison's case unless she signed a waiver, which she refused to do for fear of inappropriate use of her private information.

In 2013 about 160,000 US patients underwent weight loss surgery, which is roughly the same number of people that had it in 2004.

This amounts to approximately one percent of the estimated 18 million adults who qualify for the surgery in the US, according to the American Society for Metabolic and Bariatric Surgery.

Surgeons say a combinations of factors contribute to the slow rise in patients resorting to the weight loss surgery, including a bad economy and the shame that many feel to have to resort to the procedure. However, the main reason for people not to opt for it is insurance coverage.

Carriers insist that the surgery must only be a last resort measure and so insurance companies that cover the procedure make candidates to go through special diets and psychological evaluations before considering coverage.

"If we were talking about breast cancer, no one would be content with having only one percent of that population treated," says Dr. John Morton, professor of surgery at Stanford University. "Yet if you look at the impact of obesity on life expectancy, it's by far one of the most dangerous conditions we have in public health."

Nearly two-thirds of health plans sponsored by employers don't cover weight loss surgery, which can cost between $15,000 and $25,000.

Early indications are that the government exchanges don't cover weight loss surgery either. Only 24 states required that insurers cover the procedure and in those cases patients must pay for up to 50 percent of the cost.