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Insurance Company Won't Cover Gastric Bypass

Blue Cross Blue Shield Calls Surgery Too Risky

POSTED: Friday, February 13,

Blue Cross Blue Shield, a Jacksonville-based insurance company, said it will no longer cover gastric bypass surgery for weight loss. Starting January 2005, patients will have to pay as much as $20,000 to cover the procedure.

Blue Cross Blue Shield

Officials said the decision came after careful analysis.

Blue Cross Chief Medical Officer Dr. Robert Forster said the company is concerned about nutritional issues, having to redo the surgery, and the deaths associated with complications.

But Dr. Hosein Yasrebi disagreed, saying the procedure can help resolve at least 26 other chronic health problems.

Though gastric bypass is a way for patients to shed a lot of pounds in little time, insurers like Blue Cross argue that the surgery is too high-risk and too expensive.

John Warren, 70, said his gastric bypass surgery 15 years ago made him 312 pounds lighter. That, he said, makes him much less of an insurance liability.

Blue Cross paid for his surgery. But as the procedure gains popularity, the insurance company wants to slow it down.

"With the acceleration in popularity of this procedure, it's become expensive and there's no long-term studies on its effectiveness," said Forster.

Others feel the cost of care for health problems associated with obesity is much higher than the cost of the surgery.

People Lost Weight After Surgery

"In the long term, insurance companies save money," said Yasrebi, who practices in Jacksonville.

Six local patients spoke to Eyewitness News about the surgery, which resulted in a total loss of more than 1,215 pounds for the group, and a healthier, more productive lifestyle.

"I was self-conscious," said Sharon Gartner, one of the six patients. "I did not want to live my life like that."

As the debate continues, Blue Cross Blue Shield will stop covering the surgeries in January 2005.

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