WASHINGTON — Like 78 million other Americans, MaryJane Harrison is obese.
And like many critically overweight Americans, Harrison cannot afford to have weight loss surgery because her health insurance doesn't cover it. The financial burden makes it nearly impossible for her to follow the advice of three physicians who have prescribed the stomach-shrinking procedure for Harrison, who is four-feet, 10 inches and weighs 265 pounds.
Harrison's health insurance plan, provided by UnitedHealth, excludes coverage of any surgical procedures for weight loss. As a result, she and her family are trying to raise $15,000 to pay for the surgery that she thinks will save her life.
"I am now 53 and I don't think I'm going to live to be 55," says Harrison, 53, who lives outside of San Antonio and has tried for years to lose weight through dieting and exercise. . "When you feel your health deteriorating this fast, you know it."
UnitedHealth said it can't legally comment on Harrison's health plan unless she signs a privacy waiver. But Harrison declined to sign one due to concerns about how the company might use the information.
Harrison's case underscores a surprising trend: While the number of obese Americans persists at record levels, the number of patients undergoing weight loss surgery hasn't budged in a decade.
Last year, about 160,000 U.S. patients underwent weight loss surgery — roughly the same number as in 2004. That's only about 1 percent of the estimated 18 million adults who qualify nationwide for the surgery, according to the American Society for Metabolic and Bariatric Surgery.
"If we were talking about breast cancer, no one would be content with having only one percent of that population treated," says Dr. John Morton, professor of surgery at Stanford University. "Yet if you look at the impact of obesity on life expectancy, it's by far one of the most dangerous conditions we have in public health."
Surgeons blame a combination of factors for the stagnating numbers, including the economic downturn and a social stigma against resorting to surgery to treat weight problems. But insurance coverage is the largest hurdle, they say.
Nearly two-thirds of health plans sponsored by employers don't cover weight loss surgery, which can cost between $15,000 and $25,000. Those that do often mandate that patients meet a number of requirements, including special diets and psychological evaluations, before they can get the procedure covered.
And early signs indicate many of the same challenges seen in the private market have carried over to the new, state-run insurance exchanges that are part of the health care overhaul: Only 24 states require insurers to cover weight loss surgery for patients. And when the procedure is covered, many plans require patients to pay up to 50 percent of the cost out of pocket.
Insurers have said for years that bariatric surgery should only be used as a last resort, hence the many preliminary requirements and evaluations.
"All major surgeries are risky. This one is life altering, and if there is an approach that's less invasive and less risky for the patient, you want to try that one first," says, Susan Pisano, a spokeswoman for America's Health Insurance Plans, an insurance industry trade group.
But the insurance hurdles are pushing up against new medical guidelines urging doctors to more aggressively address obesity, including referring patients for surgery. Guidelines issued in November by the American Heart Association, the American College of Cardiology and the Obesity Society call on doctors to calculate a patient's body mass index — an estimate of body fat based on weight and height — each year, and recommend surgery for those who face the most serious health problems.
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