Utah Bill Would Mandate Insurance Pay for Gastric Bypass

Insurance companies would be required to cover gastric bypass surgery for morbidly obese residents under a bill the Utah Legislature will consider in the session that begins Jan. 15.

A 386 pound man, Jeff Haaga, urged Rep. Steve Mascaro, R-West Jordan, to sponsor the bill.

Haaga believes he will be dead soon without gastric bypass surgery.

“My doctor said, ‘You’re going to die if you don’t lose weight,'” the 52-year-old West Jordan man said.

His insurance company, SelectHealth, an Intermountain Health Care company, has denied appeals for the company to pay for the operation.

“If I paid for it myself, they don’t cover any complications from the surgery,” he said. “It could bankrupt someone like me if I got pneumonia or something else related to the surgery.”

Haaga contends that paying for the $17,975 surgery is cheaper than covering care for health problems that can accompany obesity, including heart attacks, strokes, knee and hip replacement surgeries and diabetes management.

About 100,000 people die a year due to obesity related diseases, according to the Centers for Disease Control and Prevention.

Joe Nadglowski, president of the Obesity Action Coalition in Tampa, Fla., said people are dying while fighting their insurance companies to get weight-loss surgery.

Maryland and Indiana already mandate payment for the surgery.

“We obviously feel that more coverage should be available,” said Darren Cluff with Rocky Mountain Associated Physicians in Salt Lake City, which specializes in bariatric operations. “For cosmetic reasons it probably shouldn’t be covered. But for patients with a life-threatening comorbid condition,” it should be.

Haaga’s goal is to get SelectHealth, one of the state’s largest insurance companies, to change its policies. He thinks if it agrees, other companies will follow.

SelectHealth has covered gastric bypass surgery since 2005, but it is an optional benefit that adds to premiums. Most employers don’t opt to pay the extra money.

Jeff Whipple, spokesman for Regence BlueCross BlueShield of Utah, said the mandate is of concern.

“We offer (gastric bypass surgery) to our large employer groups as an option,” Whipple said. “It’s up to the employers to choose what benefits they offer. Mandates like this can have a negative effect, because they can price employers out of offering health benefits to their employees. Legislation like this is often well intended, but it can cause economic problems down the road.”

Kelly Atkinson, executive director of the Utah Health Insurance Association, said the legislation would cause trouble for small businesses.

“When you have a piece of legislation like the obesity bill you impose it on the smallest businesses,” he said, “the businesses that are already struggling to pay for insurance.”