Monday January 12, 4:51 pm Eastern Time
Company Press ReleaseSOURCE: American Society for Bariatric Surgery
American Society for Bariatric Surgery Says Insurance Plans Need to Lighten Up on Obese Patients
New Legislation Proposed in Congress Moves to Insure That Severely Overweight Patients Like Christina Corrigan Receive Adequate Approval for Treatment
LOS ANGELES, Jan. 12 /PRNewswire/ -- The following is being issued by the American Society for Bariatric Surgery:
Who is to blame for Christina Corrigan's tragic death? Like a lot of obese people, Christina, the 13-year old, 680-pound girl who died from congestive heart failure, found the medical system unable to help her life- threatening condition. It is not unusual that her doctors were unable to treat her condition. It happens all the time, but perhaps there is help on the way.
Christina suffered from severe (or morbid) obesity (being 100 pounds or more overweight), a chronic disease according to the National Institutes of Health. It is a major killer of young and middle aged people in our society. Serious medical problems that are frequently associated with morbid obesity are increased blood pressure, diabetes, cancer, severe shortness of breath, sleep apnea, high cholesterol and heart disease just to name a few.
According to experts in the field, the only effective long-term treatment for severe obesity is surgery. Last year, thousands of patients underwent surgery to help their obesity. Many patients who have the surgery achieve normal or near-normal body weight, and that includes young adults like Christina. The NIH concurs that the only way to produce lasting weight loss is with surgery.
In 1985, the NIH officially described severe (morbid) obesity as a disease process. In 1991, it endorsed surgery as a reasonable alternative. In 1992, it confirmed the ineffectiveness of dietary approaches in this group of people.
Many health insurers, HMO's and managed care entities understand this but are unwilling to pay for obesity surgery. They state that the surgery is ``not medically necessary,'' ``experimental,'' ``unproven,'' ``marginally effective,'' or ``too expensive for the collective benefits of all.'' This is so in spite of the NIH's position that the only effective long term treatment for morbid obesity is surgery. Many denials are based on the incorrect and prejudicial bias that simple willpower or more self-discipline can cure this condition. When those who provide health care coverage for the morbidly obese refuse to cover the surgical treatment for the disease, the patients are forced to live miserable lives and many, like Christina, die prematurely.
Unfortunately, those of us who are advocates for these desperate people have little recourse because insurance companies, self-insured plans and the like are generally insulated from any liability based on their claims-handling procedures.
The Employee Retirement Income Security Act of 1974, commonly known as ERISA, all but prevents a patient from suing his or her insurance company. ``ERISA'' pre-empts all otherwise available remedies under state law (such as ``bad faith'' insurance claims-handling practices), so that companies are, at best, only liable for the benefits they should have paid in the first place, and in some limited circumstances attorney's fees.
Interestingly, bi-partisan legislation is being introduced in Congress, which would reinstate patient rights to sue their insurers or managed care plans for damages in the event they are victims of improper claims-handling practices. It is called the ``Patient Access to Responsible Care Act of 1997 (PARCA),'' introduced by Congressman Charlie Norwood of Georgia in the House, and Senator Alfonse D'Amato in the Senate. This bill will not only help the morbidly obese obtain adequate treatment for their disease and its associated medical problems, but also many others with health problems. The bill would also help many other people with health problems which are largely ignored by health insurers, simply because there are not enough people to complain about the injustice.
The last bastion of socially acceptable discrimination in our society is how we treat overweight citizens. We allow heavy folks to be treated as second rate members of society. They are discriminated against in the workplace, in the media, in all types of social situations and tragically, by their medical insurance carriers, the only group that can ultimately change the course of their life.
If passed, this legislation will reduce health problems, prolong life, and make living infinitely more pleasant for millions of your fellow Americans who are seriously overweight.
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