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Weight Loss Surgery Under Obama Care

In the midst of the screaming and hollering about the Patient Protection & Affordable Care Act (PPACA), there still is an unacceptable lack of delving into what will be covered and what will not and why. All you see on cable news is reporting at the extremes. This is the greatest piece of legislation ever (everybody can get health care now!) or this is the end of free market capitalism (long lines, big brother, death panels, technical glitches, etc.) as we know it. The truth is ALWAYS in the middle.

To be clear,¬†PPACA does provide very positive benefits like eliminating pre-existing condition exclusions and tax subsidies for lower income families. Additionally, the new legislation mandated 10 Minimum Essential Benefits for all policies issued as of January 1, 2014. However, there are several treatments that don’t directly fall under any of these categories. For those treatments that fell somewhat in between, the Department of Health & Human Services¬†left certain treatments and procedures up to the states as to whether or not to mandate coverage. One of these treatments was for bariatric or weight loss surgery.

 

Once the HHS punted many of the tougher decisions to the states, many procedures not already mandated were left alone. Hostility towards the legislation in some regions didn’t help. For example, across the deep south where obesity rates are among the highest in the country, there is no mandated coverage for bariatric surgery.

This was a stinging rebuke for many in the medical industry. In addition to the obvious benefits of the weight loss itself, many of the ripple effect issues deriving from obesity are reversed as well. Sleep apnea and high blood pressure are often brought under control after this procedure. Unfortunately, the procedure is extremely expensive with elaborate procedures costing upwards of $100,000. This is simply out of reach for many dealing with a sluggish economy and trying to make ends meet. Medicare and approximately 2/3 of large employers in the United States will cover the procedure. However, many people work for small companies and those group policies, if the small company provides group health at all, will not cover the procedure at all.

It still remains head scratching that health insurance will cover cancer and high blood pressure but won’t touch obesity on any level. So for the time being, those who would like to pursue this popular and effective procedure are left to fund it with after tax out of pocket dollars.

Premier Medical Financing is a peer to peer lending resource providing financing for elective medical procedures of which bariatric surgery is one. If you would like to get started with an application, please click here.

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