Denying Coverage of Bariatric Surgery
Complaint Filed with HHS Citing Violations of Affordable Care Act
The American Society for Metabolic and Bariatric Surgery (ASMBS) and groups including The Obesity Society (TOS) and Academy for Nutrition and Dietetics (AND), recently filed a complaint with U.S. Health and Human Services (HHS) claiming the 27 states that deny coverage for bariatric surgery are in non-compliance with the Affordable Care Act (ACA). The groups also say this failure to comply is discriminatory against women and people with disabilities and violates the ban against denying coverage based on health status or a pre-existing condition.
The ASMBS, TOS, and AND are joined in the complaint by the Obesity Medicine Association (OMA) and the Obesity Action Coalition (OAC), a patient advocacy group with more than 50,000 members. All five groups belong to the Obesity Care Continuum.
John Morton, MD
"Qualified health plans should not be able to discriminate against people with the disease of obesity and unfortunately this is happening in most states,” said John M. Morton, MD, MPH, Immediate Past President of the ASMBS. “HHS has the power to change this and extend coverage to all 50 states. That’s why we filed the complaint.”
Dr. Morton noted that treatment for chronic diseases other than obesity are routinely covered. Obesity was classified as a disease by the American Medical Association (AMA) in 2013.
“There’s a double standard when it comes to obesity,” Dr. Morton added. “Most insurers are covering the treatments for the complications and consequences of obesity, but are not covering the treatment of obesity itself.”
In the complaint, the groups say there is a significant disparity between the 27 ACA benchmark plans that deny or exclude bariatric surgery from coverage, and the major private and government health insurance plans that offer it. Medicare, 49 state Medicaid plans, the Federal Employees Health Plan, the majority of state health plans, and the majority of employer-based plans with 500 employees or more also cover bariatric surgery.
The groups charge that states not offering coverage of bariatric surgery violates the provision of the ACA that prohibits denying coverage to people due to an existing disability (obesity is considered a disability under the American Disabilities Act) and with discriminating against women, who account for about 80 percent of the bariatric operations performed in the United States.
The ACA states a qualified health plan may “not employ marketing practices or benefit designs that have the effect of discouraging the enrollment of such plan by individuals with significant health needs.”
"We believe there should be a single, consistent obesity health benefit for the entire country, and as part of that benefit, proven obesity treatments such as bariatric surgery should be covered for those who need it," said Dr. Morton.
Raul Rosenthal, MD
Studies have shown individuals with a body mass index (BMI) greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals, as well as an increased risk of developing more than 40 obesity-related diseases and conditions including Type 2 diabetes, heart disease and certain cancers. In 2013, the American Medical Association (AMA) declared obesity a disease.
“Access to care is a life and death issue and we will continue to fight on behalf of our patients,” said Raul Rosenthal, MD, president of the ASMBS.