My column last week on a nearly 500-pound Norwalk man whose health insurer won’t cover doctor-ordered weight-loss surgery stirred quite a response from readers.
Many sympathized with 53-year-old Shawn Alvarado’s situation, acknowledging that, in his case, a gastric bypass operation couldn’t be considered a cosmetic procedure.
They reacted with astonishment that Alvarado’s insurer, Minnesota-based HealthPartners, would be willing to pay hundreds of thousands of dollars to cover his various obesity-related complications, yet wouldn’t tackle the condition head-on with a roughly $20,000 operation.
Others, however, especially the more than 100 readers who commented online, sided with the insurer, saying Alvarado’s weight was his own problem.
Then there was Dr. Hooman Shabatian, a Tarzana bariatric surgeon, who read Alvarado’s story and contacted me to say he’d be happy to perform the operation for free.
“Calling this a cosmetic procedure is insane, it’s absurd,” Shabatian said. “There’s nothing cosmetic about losing hundreds of pounds of fat around your heart, your liver.”
He went on to say that if Alvarado qualifies for the operation, he could lose as much as 200 pounds. The rest will be up to him.
“We have to start treating obesity as a medical condition,” Shabatian said. “Some of it may be genetic or socioeconomic, but at some point people enter a cycle of obesity that goes on and on, and then they get all the expensive conditions that come with it.”
His generosity is significant and laudable, and may save Alvarado from an early death.
Props as well to Dr. Ninh Nguyen, chief of gastrointestinal surgery at UC Irvine, who got in touch with me late Tuesday with an offer to meet Alvarado for a consultation and to “call his insurer to see if anything can be done.”
Yet it troubles me that good Samaritans had to step forward because the U.S. medical establishment failed to act.
I understand there’s an element of personal responsibility to this story that shouldn’t be overlooked. I also understand that insurers need to draw the line at most elective surgeries to keep rates down for policyholders.
But we’re living in a time when more than 36% of U.S. adults are obese, according to the Centers for Disease Control and Prevention. Over 70% of American adults are obese or overweight. It costs about $170 billion a year to treat obesity-related medical problems.
For insurers to place blanket prohibitions on weight-loss surgery, particularly in cases of morbid obesity, ignores the scope of the problem. It’s also just bad business.
Last year, Alvarado was hospitalized for congestive heart failure. His insurance company covered most of the $100,000 bill. It also pays tens of thousands of dollars annually to deal with Alvarado’s Type 2 diabetes, high blood pressure, high cholesterol and sleep apnea.
Yet it won’t cover at least a portion of a $20,000 procedure that could limit or even end most of those costly problems?
From a financial point of view if nothing else, that’s just dumb.
HealthPartners didn’t respond to a request for comment.
I spoke with Alvarado. He has already contacted Shabatian’s office and is looking forward to an examination.
If all goes well, a gastric bypass could give him a shot at a normal life, which seems like a reasonable thing for anyone to ask for.
As Shabatian told me: “That’s not cosmetic. It’s not like this guy is going to become a runway model. But maybe he’ll be able to do things that other people can do.”
Which sounds suspiciously like what health insurance is for.