It might be an unfair overgeneralization to say that insurance companies make people sick, but a study presented at the annual meeting of the American Society for Metabolic & Bariatric Surgery looking into the consequences of morbidly obese patients who were denied coverage for bariatric surgery confirms that, in this population, insurers often stand in the way of helping people get well.
Dr. Ayman B. Al Harakeh and colleagues at Gundersen Lutheran Medical Foundation in LaCrosse, Wis., compared the natural history and metabolic consequences of morbid obesity for patients who were denied bariatric surgery (despite satisfying NIH criteria and being deemed appropriate candidates) to that of patients who underwent laparoscopic Roux-en-Y Gastric Bypass at their institution from 2001-2007. Compared with the 587 patients in the LRYGB cohort, the 189 patients in the denials cohort were significantly more likely to develop new comorbidities, including diabetes, hypertension, obstructive sleep apnea, lipid disorders, and gastroesophageal reflux disease within a 3-year follow-up period, despite no change in BMI.
Because the data for the study were collected retrospectively through a medical record review, the specific reasons for the insurance denials were not available, according to Dr. Al Harakeh, who nonetheless lamented insurance companies’ apparent ability to deny bariatric surgery arbitrarily: “Often, they just don’t want patients to have the surgery because of the high economic impact. We see that happen all the time.”
The findings indicate “a clear and present danger to at-risk obese patients,” according to discussant Dr. John Morton, director of bariatric surgery and surgical quality at Stanford Hospital and Clinics in Palo Alto, Cal., who stressed the need to investigate and, when appropriate, fight the insurance denials.
Dr. Al Harakeh and Dr. Morton disclosed no financial conflicts of interest.
—Diana Mahoney (Twitter @DMPM1)