New Media Producer: Brad Maglinger
Blue Cross and Blue Shield of both Florida and Nebraska will stop covering gastric bypass surgery. The company cites safety concerns as the main reason. Plus, the huge demand for the surgery could end up costing insurers over $200 million over the next few years, which would lead to higher premiums. Here in Indiana, the state requires companies to offer it, but that doesn't mean everyone who wants it is getting it.
When we first met Candie Randall, she weighed 330 pounds and didn't have the stamina to care for the children in her home daycare. Having failed with traditional diets, Candie wanted to have gastric bypass surgery, but her husband's insurance company wouldn't cover it.
Nearly two years later, that's still the case. "I wrote my congressman and my senators and the CEO of the company, and they still denied me and pretty much told me to stop writing letters and calling that they would let me know if they ever decided to cover medical weight lossm," says Candie Randall.
Indiana statute mandates state health plans cover the surgery. Private insurance companies are required to offer it to employer groups, but, "It is totally within the employer's discretion whether he is going to have that as part of his employee's health plan or not," says Indiana Department of Insurance spokesperson Adrienne Quill.
Besides the $30,000 cost of the surgery that may lead to higher premiums, employers may decide not to offer the surgery because of the complications; three of every 1000 patients die.
The Vanderburgh County Judicial System recently lost one of its own when Magistrate Nancy Hankins Long suffered internal bleeding and cardiac arrest three weeks after her surgery. But this area has its share of success stories too. New Harmony resident Vicki Woods lost 150 pounds and says if there is a true safety concern with the surgery, insurance companies need to look into fixing it instead of simply dropping it.
Vicki's picture hangs on Candie Randall's refrigerator for inspiration, even though she's feeling defeated by her insurance company.
At this point, she says she doesn't think she would have the surgery even if she could. Candie's lost 54 pounds through weight watchers and exercise, and believes this is the way she was meant to do it.
Not that Candie Randall doesn't think other people should get the surgery if they want it. She thinks insurance companies should cover it, otherwise many people will suffer.
And she says those people will end up costing their insurance companies more in the long run when they make claims for obesity related diseases. So, the argument is pay now or pay later.