Health insurance logic
For years, Bob Clegg’s insurance company paid out some $3,000 a month for doctor visits, drugs and medical devices to treat the health problems caused by his obesity.
In September 2007, when his weight peaked at 380 pounds (172 kg), he had gastric bypass surgery, and now his health issues — joint pain, sleep apnea and esophageal problems — have vanished, and so have the medical bills.
But even though the surgery — in which the stomach is made smaller and part of the intestine is bypassed — has saved his insurance company money, Clegg, who now weighs 240 pounds (108 kg), had to pay the $20,000 cost out of his own pocket.
“It wasn’t until the doctor said my sleep apnea was at a point where we seriously had to consider a tracheotomy that we talked about gastric bypass,” said Clegg, 54. “The irony is that insurance would pay for the tracheotomy, but not the surgery.”
I suspect part of the reason health insurance companies are reluctant to pay for gastric bypass procedures is that the terms for insurance contracts tend to be short, say two years, and people tend to change insurance fairly frequently. The insurance companies are worried they will spend a lot of money for a gastric bypass and then the patient will change insurance companies and some other company will reap the benefits in lower expenditures on health care.
Of course, short-term thinking — by business, government, and individuals — accounts for a lot of America’s current problems, both within and outside health care.