Insurance for gastric bypass is sought

As a 19-year-old woman weighing 348 pounds, Genevieve Winegar had tried everything to lose weight, from the standard diet and exercise to more radical options like hypnosis.

"You name it, I tried it," the Draper woman said, noting that with each failure, she sank into a deeper depression. Winegar's obesity also caused her to suffer from acid reflux disease, sleep apnea and an acute cough. Then she sought gastric bypass surgery.

Now, five years later, she weighs 145 pounds and her weight-related conditions are gone.

Winegar told her story — complete with a DVD presentation filled with before and after photos — to members of the Legislature's Health and Human Services Interim Committee Wednesday. She came to the state Capitol to lobby for draft legislation that would require Utah health insurance providers to allow employers to purchase coverage for surgery to treat morbid obesity.

Covering procedures such as gastric bypass surgery will save insurance companies money in the long run by reducing the money spent on disorders caused by obesity, such as type 2 diabetes, said Joseph Nadglowski, president of the Obesity Action Coalition, a national advocacy organization.

Opponents of the legislation, however, argue that requiring health insurers to cover such surgery would increase insurance costs for people who already struggle to afford coverage, said Kelly Atkinson, executive director of the Utah Health Insurance Association.

In Winegar's case, her insurance covered 90 percent of the cost for her surgery, leaving her to pay about $1,200. The procedure normally costs between $18,000 and $24,000.

Utah's two largest health insurers, SelectHealth and Regence BlueCross BlueShield, already allow employers to purchase coverage for morbid obesity surgery, according to the Utah Health Insurance Association. Only two — including the Public Employees Health Plan, which insures most lawmakers — exclude the surgery from their coverage plans.

About 20 percent of adults in Utah are obese, and about 5 percent are morbidly obese (more than 100 pounds overweight), Nadglowski said. According to the state health department, $393 million was spent on medical costs for obesity-related diseases between 1998 and 2000.

Nadglowski said obesity is not simply caused by laziness or gluttony, but is a complex medical issue that is heavily impacted by genetics. It is equally important, he said, to prevent obesity as it is to treat those who are already obese.

"The battle on obesity must be fought on two, and in my opinion, equally important fronts," Nadglowski told lawmakers.