Bariatric surgery has been shown to be an effective treatment for adolescents with severe obesity. Yet, many providers express hesitance to refer adolescents for surgery due to concerns for insufficient insurance coverage based on age.
The Healthy Lifestyle Clinic, an interdisciplinary pediatric weight management clinic, was established in 2014, and an adolescent bariatric surgery program was added in 2017. Patients aged 15 years and older who meet specific criteria are eligible to start the bariatric surgery track, which includes 6 monthly preoperative interdisciplinary visits. The purpose of this study was to describe insurance coverage for laparoscopic sleeve gastrectomy (SG) in the first 18 months of this program. A chart review was done to extract information about insurance type and approval on 17 patients.
16 of 17 patients (94%) for whom insurance coverage for SG was sought were approved. Of these, 10 (62.5%) had public insurance (encompassing 3 state’s Medicaid programs) and 6 (37.5%) had private insurance. 7 (44%) were < 18 years at the time of approval, and all 7 of these patients had public insurance. 7 (44%) patients were approved after the initial application, 5 (31%) required additional information to be submitted, and 4 (25%) required either an appeal or peer to peer. Number of contacts with the insurance company ranged from 1 to 17 with 5 patients (31%) requiring >5 contacts. 1 patient was interested in SG but it was not an included benefit under the private insurance plan.
Age < 18 years and having public insurance have not been barriers to insurance coverage for SG in our clinic thus far. Adolescent bariatric surgery programs should be prepared to have multiple correspondences with insurance companies in order to receive insurance approval. Referring providers and primary care providers should not delay referral for bariatric surgery for adolescents with severe obesity based on age or fear of insufficient insurance coverage.