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Child and teen obesity is a growing problem, and the latest trend in treatment methods is bariatric surgery. But, as NPR reports today, many insurance companies won’t cover weight loss surgery for teens. But for all the outrageous exemptions that insurance companies make, I have to say: I don’t think this is one of them. Why should insurance companies cover a high-risk surgery that has questionable effectiveness for teens…many of whom probably haven’t had adequate time to test whether nutrition and exercise could work?

NPR reports that many private insurance companies frequently decline the $20,000 procedure because of risk and unproven effectiveness, but Medicaid and the Children’s Health Insurance Program (CHIP) is more likely to cover it:

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.”

But weight loss surgery champions will sometimes “get around” insurance policies or pressure companies into covering the surgery, according to NPR:

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.

I know: Not all obesity is caused by overeating and lack of exercise. And for some, bariatric surgery could be a life-saving, last-ditch effort that insurance companies should cover. But teens aren’t even finished growing, and researchers don’t seem to be finished determining how effective—or safe—weight loss surgery is for kids under 18. And it seems to me that if child and teen obesity is getting to the point where insurance coverage on surgery is a common concern, then doctors and nurses should be pounding down the doors of executives at fast food companies, or the government officials who just declared pizza a vegetable in school cafeterias?

It’s sad that we’ll worry over who should pay for expensive surgeries, when it’s hard to get anyone to give a damn about preventing child and teen obesity to begin with. If Medicaid, CHIP, and private insurance companies put the same money towards teaching kids the importance of a whole foods-based diet and exercise, I doubt they’d be nearly as worried about who should pay for the new trend in teen weight loss surgery.


Posted 11:53 AM

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