Lawmakers consider bill mandating insurance coverage for weight loss surgery

Hartford Courant (CT)

At 48, Eric Berthel suffered from hypertension, sleep apnea and intense joint pain.

But after undergoing bariatric surgery in 2015, he lost 160 pounds and, he said, those ailments disappeared.

Berthel, a Republican state senator from Watertown, is championing a bipartisan bill that would require insurers to cover bariatric surgery and similar procedures to treat severe obesity. "This is good medicine and its the right thing to do for the people we represent,'' he said.

The legislature’s insurance committee held a hearing on Senate Bill 204 Wednesday. Lawmakers heard from dozens of people who underwent such surgeries and spoke of their effectiveness.

Among them was Cindy Ressler, a paralegal from Middletown, who underwent gastric bypass surgery in December.

"I had been overweight most of my life,'' Ressler said. Her doctor told her she was morbidly obese and she started getting chest pain. “I was 48 at the time and thought ‘oh boy, I got to do something.’”

Ressler, who is now 50, said she had to overcome several hurdles to get insurance to cover ther surgery. Initially they told her she would have to foot the entire $40,000 bill.

Eventually Ressler and her doctors convinced the insurance company the procedure was medically neccesary. “It took all of 2019,” she said. “I had to have psych evals, nutritional counseling, a sleep apnea test, colonoscopy, endoscopy, every -oscopy you can think of!”

The experience was "life changing and life saving,'' Ressler said. “I didn’t realize how much I couldn’t do until I started doing things again.”

Currently 23 states have similar mandates. Berthel proposed a similar bill last year but it died in the legislature’s appropriations committee after concerns were raised that it could cost the state $4.4 million annually to cover the cost of such surgeries for people who receive insurance through the Affordable Care Act.

Berthel said he is hopeful the measure will win passage this year. It has the support of the insurance committee’s Democratic co-chairman, Sen. Matt Lesser of Middletown.

Medicaid and Medicare, along with some private insurance plans, already cover the procedure. If the bill passes, the mandate would only apply to group and individual plans, not the increasing numbers of companies and government entities that self-insure.

Critics say the additional costs are too much for small businesses to bear. "Mandates drive up costs because with each new requirement, insurers must expand coverage to include additional services or devices,'' Michelle Rakebrand, assistant counsel for the Connecticut Business & Industry Association, a lobbying group, said in written testimony to the insurance panel. “This in turn increases the cost of health insurance premiums, and those increases are passed directly onto enrollees.”

Bariatric surgery encompasses a number of medical procedures. A lap band, which is a device to surgically placed around the top of the stomach to reduce food consumption, typically costs between $15,000 and $20,000. A gastric sleeve, which involves a removal of a portion of the stomach, can cost $20,000 to $25,000 and a gastric bypass can cost $30,000 or more.

Berthel acknowledged the cost, but noted that patients who undergo such surgeries often lower their risk for heart attack, stroke, diabetes and other illness that cost a great deal to treat and can severely impact a patient’s quality of life.

"It’s not a magic pill,'' Berthel said of the surgery. “You have to make lifestyle changes. But basically it can give people their lives back.”

Dr. Neil Floch, the director of bariatric surgery at Nuvance Health Network based at Norwalk Hospital, said there’s a misperception that losing weight is a matter of willpower and self control. Obesity is recognized by the American Medical Association as a chronic metabolic illness that can put a patient at risk for a host of related complications, including heart disease, diabetes and cancer.

“This isn’t about people eating too much and not exercising,” Floch said. “Metabolic surgery isn’t just about making a smaller stomach. It’s changing our hormones...and a lot of other complicated things that reverse the problem we now have, which is obesity.”

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