To Potential Bariatric Patients, from a Surgeon

letter bariatric surgeryThis is an open letter from Dr. Robert Michaelson, Vice President, Washington State Chapter of the American Society for Metabolic and Bariatric Surgery, to potential bariatric surgery patients.

Something You Should Know: You are actively being discriminated against by your insurance company.
by Robert Michaelson, M.D., Ph.D., F.A.C.S., F.A.S.M.B.S.

Over the past 18 months or so, several insurance companies have implemented mandatory preoperative diet and exercise programs. Some of the programs are three months in duration, but increasingly we are seeing requirements for 6 months, 9 months, and even 12 months. The programs are sometimes referred to as “Surgical Preparatory Programs,” and the rational from the insurers is that these programs will enhance surgical outcomes, i.e., greater weight loss and fewer complications.

The American Society for Metabolic and Bariatric Surgery (ASMBS) is dedicated to improving public health and well being by lessening the burden of the disease of obesity and related conditions. It is the largest such organization in the world, and establishes guidelines for the practice of bariatric surgery.

ASMBS reviewed this recent practice employed by insurers in the “ASMBS Position Statement on Preoperative Supervised Weight Loss Requirements.” The findings of this review are that there are no studies or evidence-based reports that document the benefits or the need for a preoperative dietary weight loss program before bariatric surgery. This practice is a barrier to needed care which results in attrition of patients from bariatric surgery programs.

“It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and circumstances of the patient.”*

As a patient in need of this surgery, what can you do?

  • Inform your human resources department – this is discrimination (lung cancer patients are not mandated a 3, 6 or 9 month period of smoking cessation before life saving surgery).
  • File a complaint with the Washington State Insurance Commissioner
  • Band together in the workplace and file a class action law suit (inappropriate and capricious delay of necessary health care).
  • Contact your Senators and Congressional Representatives

Nothing will change unless you act.

*The full text can be viewed here.

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