In December, National Public Radio (NPR) ran an article Insurers Often Don’t Pay For Teen Weight-Loss Surgery describing the difficult situation facing adolescents in need of weight loss surgery. For adults, standard bariatric procedures are usually covered, whether by employers, Medicaid, or some other form of insurance; in teens, however, coverage is not so easily obtained. We asked Jeffrey L. Zitsman, MD, Director of the Center for Adolescent Bariatric Surgery at NewYork-Presbyterian Morgan Stanley Children’s Hospital/Columbia University Medical Center, to explain what the situation was like here in New York.
According to Dr. Zitsman, only two institutions in the New York area have been approved by the FDA to offer adolescent bariatric surgery as part of limited studies investigating laparoscopic gastric banding in patients under age 18. If patients qualify for surgery according to the study criteria, they can obtain laparoscopic banding at these select institutions. Although the surgery is permitted in adolescents as part of the study, payment is still required. Yet Medicaid plans and most private insurance policies are not consistent in their coverage, nor are they always eager to cover costly surgical procedures, even despite the clear health – and financial – benefits associated with significant weight loss.
As a result, Dr. Zitsman has had to appeal to most of his patients’ insurance companies in one form or another, to a greater or lesser degree, to secure coverage for treatment. “Even for patients who have private insurance, I often have to fight for coverage. In some cases, a patient’s insurance plan does not cover the surgery, and he or she changes to another plan that does.”