Current Weather
The Spy FM

Insurers Often Don’t Pay For Teen Weight-Loss Surgery

Filed by KOSU News in Health.
December 13, 2011

Weight-loss surgery for morbidly obese teenagers is getting some traction, when diets and exercise fail.

Getting the procedure paid for is another matter, since many insurers and employers are still wary of covering it for children. The surgery costs upwards of $20,000, and it’s still being evaluated to determine which adolescents would benefit most from it.

Clinicians say kids who are covered under the Medicaid program may actually have an easier time getting insurance to pay than those in private plans.

If kids are covered by Medicaid or CHIP, the Children’s Health Insurance Program, “We know they’re covered in Texas,” says Trish Walters-Salas, a nurse case manager who handles insurance authorizations for the adolescent bariatric surgery program at Texas Children’s Hospital in Houston. “But if it’s commercial insurance, it’s employer-driven and it’s based on what the employer has selected for employees.”

Forty-seven state Medicaid programs cover bariatric surgery in adults, according to the American Society for Metabolic and Bariatric Surgery. But it’s not clear how many of those states pay for the surgery for teens.

Ohio is one that does. “We had to spend time talking to Medicaid directors in Ohio over several years to get on same page in terms of what we were offering these kids,” says Dr. Marc P. Michalsky, surgical director at the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus. “In Ohio, at least half our [adolescent bariatric surgery] patients are Medicaid recipients,” he says.

Adolescent obesity specialists caution that weight-loss surgery must be undertaken cautiously in young people. In general, hospitals require that, among other things, surgical candidates must have tried to lose weight through diet and exercise and been unsuccessful and have reached their adult height. They also must be mature enough to make profound changes in what their dietary and other changes that the surgery requires.

Fifty-six percent of employers with between 1,000 and 5,000 employees cover the procedure in adults, according to human resources consultant Mercer.

At some companies, bariatric surgery may be specifically excluded for anyone under age 18, says Walters-Salas, the Texas nurse. If that’s the case, “then forget it,” she says. “But if it’s simply not a covered benefit, there are ways to get around it.”

Walters-Salas is quick to pick up the phone to call decision-makers, whether it’s the medical director at an insurance company or a corporate executive, to persuade them to cover the surgery.

She called the president of a company once to lay out a case for covering the surgery in a 15-year-old. “I said, ‘Here’s what we’re up against,’ ” she remembers. “This child is not going to make it to her 20th birthday.’”

The hard sell worked. She tells parents who think their child needs surgical help to keep pushing. “Sometimes people give up too soon,” she says. [Copyright 2011 Kaiser Health News]

Leave a Reply

12AM to 5AM The Spy

The Spy

An eclectic mix of the Spy's library of more than 10,000 songs curated by Ferris O'Brien.

Listen Live Now!

5AM to 6AM Living On Earth

Living On Earth

Living on Earth with Steve Curwood is the weekly environmental news and information program distributed by Public Radio International.

View the program guide!

6AM to 7AM On Being

On Being

On Being engages listeners across the spectrum of belief and non-belief in conversation about life's deepest questions. From autism to the ethics of torture, Krista and her guests reach beyond the headlines to probe faith and meaning, ethics and new ways of being, amidst the political, ecological, economic, cultural and technological shifts that define 21st century life.

View the program guide!

Upcoming Events in your area (Submit your event today!)

Streaming audio and podcasts

Stream KOSU on your smartphone

Phone Streaming

SmartPhone listening options on this page are intended for many iPhones, Blackberries, etc. with low-cost software applications available to listen to our full-time web streams, both News on KOSU-1 and Classical on KOSU-2.

Learn more about our complete range of streaming services

We're perfecting the patient experience - Stillwater Medical Center