Positive Insurance Changes Allow Weight Loss Surgery Sooner

Positive Insurance Changes Allow Weight Loss Surgery Sooner

Insurance Coverage for Weight Loss Surgery in the Us

New Weight Loss Procedures in the United States: Unfortunately we rarely hear positive news about health insurance coverage in America. But today, I have some good news in relation to weight loss surgery in the US. Insurance company, Cigna has made a major change in it’s preoperative requirements to qualify for bariatric weight loss surgery. We’re going to discuss why this change could greatly benefit patients hoping to undergo life-changing weight loss operations. 

First, some background information about US healthcare and weight loss operations. Around 12 years ago, Medicare added a requirement to qualify for weight-loss surgery. Each patient had to attend 6 consecutive months of medically supervised weight-loss classes. These weight loss classes were to be completed within 2 years in order to qualify for weight loss surgery. However if a patient missed a weight loss class for any reason, they had to start all over again, putting them back 2 years in their weight loss journey. Each of the major insurance carriers in the US, quickly added this pre-operative requirement to their health insurance policies that include bariatric surgery benefits. This meant that a huge number of weight loss patients had to wait 6 months before they were considered fit for surgery. 

Weight Loss Surgery & US Insurance Companies 

On the other hand and interestingly, there were no scientific studies published to support this requirement at the time. In response, the medical community in the US developed several studies to determine if a 6-month medically supervised weight-loss class was beneficial. The research intended to answer the question, Did the classes produce better overall outcomes for weight loss and fewer complications associated with surgery? 

Shockingly, the medical studies found no difference in weight loss success between patients who attended a 6-month weight loss class versus patients who didn’t. In fact, the studies also found that a delay in weight loss surgery, actually led to some patients experiencing complications due to their medical comorbidities. In conclusion, this delay could potentially cause harm to patients looking to undergo weight loss surgery with chronic illnesses such as type 2 diabetes. So, while patients were attending weight loss classes, they were still suffering with poor health due to their obesity. 

Medicare & Weight Loss 

Medicare was presented with the data from the studies for review. After analysing the results, Medicare decided to drop the requirement from its plan about 5 years ago. The major insurance carriers were provided with the same information but continued with the requirement until July of this year. 

Cigna is the first to drop the 6-month medically supervised weight-loss class requirement. So, if you have Cigna healthcare insurance with bariatric cover and your primary-care physician or dietician can demonstrate an unsuccessful weight loss attempt, you will likely qualify for weight loss surgery. While there are still other standard requirements that you must meet, it does mean that weight loss surgery could take place within 4-6 weeks, instead of 3-6 months. This certainly is good news for those suffering with comorbidities such as type 2 diabetes or high blood pressure. 

Cigna & Weight Loss Patients

Therefore, the decision by Cigna is a very positive step for patients who suffer from morbid obesity in America. Certainly, this will improve access to weight-loss surgeries such as robotic bariatric procedures, including the gastric bypass, sleeve gastrectomy, and revisional procedures. Such accessible healthcare will lead to a reduction in, and resolution of, comorbid conditions associated with obesity. 

Obesity related comorbidities include illness such as: 

  • Type 2 diabetes
  • Hypertension
  • Sleep apnea
  • High blood pressure 

If you know anyone who works for Cigna, I urge you to thank them. With such promising news, I am hopeful that other health insurance companies will follow suit quickly. Plus it will allow their morbidly obese patients to seek more efficient treatment and begin their weight loss journey sooner. This will help patients suffering from comorbid conditions and is great news for everyone. 

Why is Weight Loss Important in the US 

According to recent data, it’s estimated that almost two thirds of Americans are considered overweight or obese. Obesity is a massive problem in the United States and it can put a huge strain on the healthcare industry. Nether the less, obesity is on the rise and affecting adults as well as children. As obesity is a chronic disease that requires on-going treatment and medical care, insurance companies in American will often add requirements before providing obesity coverage. 

The annual healthcare cost of obesity-related illness in American is around $190 billion. This is around 20 percent of the yearly medical bill in the US. The cost of fighting obesity includes treating the comorbidites assosiated with being obese. These conditions can include diabetes, heart disease, high blood pressure, sleep apnea and in some cases cancer. A poor diet and a lack of physical activity increases a person’s risk of developing illnesses. 

So, if we take type 2 diabetes as an example. This chronic disease can cost a patient up to $16,750 a year in medical bills. This expenses includes medical supplies, hospital trips, visits to the doctor, medical prescriptions and loss of income due to the disease.  Looking at this comorbidity alone, we can begin to understand why insurance companies are concerned. Yet, bariatric weight loss surgery can significantly help patients with obesity and reduce medical bills related to comorbidities such as type 2 diabetes.

Fighting Obesity in America 

Often patients suffering from obesity struggle to lose weight within medical intervention. Weight loss procedures such as robotic bariatric surgery can help save lives and give a patient a better quality of life. Thankfully, insurance companies that help people with obesity undergo weight loss surgery are leading the way in fighting obesity in the US. By choosing to drop the 6 month medically supervised weight loss class requirement, patients can access weight loss surgery faster. In spite of this, not all healthcare providers are dropping this requirement. 

By giving US citizens the opportunity to access life-changing weight loss operations sooner, the impact of obesity related chronic illnesses can be reduced or resolved. We hold these healthcare insurance companies in high esteem. We only hope that other insurance providers can follow suit. 

Colorado Bariatric Surgery Institute

Finally, at the Colorado Bariatric Surgery Institute, we are pleased to say the all of our weight loss procedures are performed with the most state-of-the-art robotic instrumentation. This allows for a more precise weight loss operation and results in less pain and a faster recovery for patients. If you have any questions regarding your healthcare insurance, please feel free to call our office on 303-861-4505. We provide weight loss patients with free healthcare insurance evaluations to help you to determine your personal bariatric coverage. Also if you’d like more information about robotic Bariatric Surgery in America, feel free to contact our experts today. 

If you’d like to know more about weight loss surgery at the Colorado Bariatric Surgery Institute please check out our recent articles on:

Am I a Candidate for Bariatric Surgery?

Benefits of Medical Robots in Bariatric Surgery

Preparing for Weight-Loss Surgery

Thank you for taking the time to read this article. I hope it has provided insight into robotics Bariatric Surgery in the US.

Best wishes,

Tom Brown, MD

Colorado Bariatric Surgery Institute in Denver, Colorado

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