One-in-five surgically eligible patients denied insurance for bariatric surgery, study finds

New Study Finds Mortality Rate Tripled Among Patients Delayed or Denied Insurance Approval for Bariatric Surgery

University of North Carolina (UNC) researchers found patients who were denied or delayed insurance approval for bariatric surgery, despite being cleared by their medical team, had a mortality rate three times higher than patients who received insurance approval without delay.

According to the study, about one-in-five (22%) surgically eligible patients were initially denied by their insurance provider, and within a five-year period 6 percent of them died, compared to less than 2 percent of those who received insurance approval. The study followed 463 patients who were cleared for surgery by a multidisciplinary medical team (surgery, psychology and nutrition providers) from the UNC bariatric surgery program between 2003 and 2008.

The research was presented here at the 30th Annual Meeting for the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2013, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The event is hosted by the ASMBS and The Obesity Society (TOS).

“For people with morbid obesity, bariatric surgery provides a significant survival benefit,” said study co-author D. Wayne Overby, MD, a bariatric surgeon and Assistant Professor of Surgery at UNC Department of Surgery. “In this light, there seems to be no justification for employers, insurers or government payers to deny patients who meet evidence-based medical criteria from having access to it.”

The study included 391 females and 72 males, whose average age was 45 and whose average body mass index (BMI) was 52.5. Nine of the 100 patients who were initially denied surgery were eventually able to overturn their denial and have surgery. UNC researchers measured patient mortality using the Social Security Death Index.

“Whether from uncontrolled obesity-related co-morbidities or from downstream treatment complications, reduced survival associated with denial or delay in bariatric coverage must be considered when implementing national and state policies around bariatric surgery,” said Eleisha Flanagan, MD, lead study author and Fellow in Minimally Invasive Surgery at UNC Hospitals.