Medicine Essay on Gastric Bypass and Sleeve Gastrectomy Bariatric Surgery

Bariatric surgery has become paramount in the health care sector in the current years. Along with this explosion of the procedures, the surgery has been met by an upheaval of whether or not insurance companies should cover the subjects involved in the surgery. That is whether or not the insurance companies should take part in the payment of the procedures. For this reason, this essay will involve a background digging into the facts behind the conducting of Bariatric surgery and the essence of insuring the procedures. Consequently, a personal insight of the same will be provided all with support from secondary sources.

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Notably, Bariatric surgery can simply be defined as the weight loss surgery in which the people with obesity or those with disorders such as the Body Dysmorphic Disorder (BDD) are subjected. The procedure, therefore, entails the surgical removal of body fat through procedures such as the gastric band weight reduction, sleeve gastrectomy or biliopancreatic diversion that is commonly referred to as the gastric bypass surgery. There have been studies which have associated this procedure with the overall reduction of the mortality rates of the obese people from 40% to 23%. At the same time, these weight reduction procedures have been documented by Robinson (2009), in his research, to have significant long-term effects on weight loss and to induce recovery from diabetes while at the same time improving recovery from cardiovascular risk factors that come about due to obesity.

Putting the insurance companies into consideration raises the questions of whether or not the procedures should be insured against. In most case, the procedures are seldom covered by the insurance companies unless they are as a result of clinically severe obesity. This means that the procedures should be medically necessary so as to be paid for by the insurance companies. For instance, the MO HealthNet Division and the Colorado Medicaid covered the procedures only if there is prior authorization and proved the necessity of the procedures by the medical attendants of the specific patient. However, the insurance companies recommend the use of exercise and other nutrition methods to curb obesity rather than use the mentioned surgical procedures (Colorado Medicaid Benefit Coverage Standard, 2015). In this case, not all people who want the procedures done are covered.

Specifically, those with medical co-morbidities are insured for the surgical procedures. In this case, the common co-morbidities according to Colorado Medicaid Benefit Coverage Standard (2015) include severe cardiac diseases such as cardiomyopathy and coronary artery disease; type 2 diabetes mellitus, severe respiratory diseases such as obesity hypoventilation syndrome or obstructive sleep apnea; hyperlipidemia; hypertension; pseudo-tumor cerebri; significant impairment in Activities of Daily Living; and severe joint or disc disease which impairs daily functionality of the body.

From my point of view, obesity is among the number one causes of chronic diseases revolving around abnormal blood pressure, diabetes and impaired body functions. As such, it is good that any possible solutions to mitigate the effects of obesity be adopted as often as possible. In this case, especially in the severe cases, I agree that the insurance companies should pay for the Bariatric Surgery procedures. At the same time, I agree that not all people should be insured since there are other cheaper solutions to mitigating the effects of obesity. In other words, there should be strictly stipulated standards that any client seeking payment for payment for the surgical procedures should adhere to for qualification for the same.

I am in support of such standards as the one that requires that the insurance cover pay for those with the mentioned co-morbidities since the insurance policies are aimed at ensuring the well-being of the subject patient. In addition to this, I agree that those with Body Mass Index of a greater or equal to 40 and or those with BMI of 35 or more and have in addition to the BMI one or more of the mentioned co-morbidities. This I can relate to the study done by Robinson (2009) which affirms that the people with BMI above 35 should be considered for Bariatric Surgery, which means that it can be regarded as a medical requirement for the surgery. Therefore, there arises a need for the insurance companies to support those have this conditions and BMIs so that they can get the surgery. The financial support becomes crucial as the conditions of the specific patients get worse.

In conclusion, Bariatric surgery is a crucial part of improving those with severe obesity conditions especially those linked to co-morbidities conditions. Based on the fact that this surgery is quite costly, I am of the opinion that the insurance companies get to pay for the procedures. By that, I mean to support the idea that not all people found obese should expect to undergo surgery with the funds coming from the insurance companies. Instead, the set standards of the insurance policy should be strictly followed, and the least undeserving cases of obesity be let to curb their condition in other possible and less costly ways such as exercise and observing diet.

References

Colorado Medicaid Benefit Coverage Standard. (Reviewed 2015). Bariatric Surgery. Pp 1-8.

Robinson, Malcolm, K. (2009). Editorial Surgical Treatment of Obesity---- Weighing the Facts. New England Journal of Medicine. 361(5): 520-521. doi: 10.1056/NEJMe0904837