Device makers urge coverage of weight-loss surgery

Device manufacturers are pushing the government and health insurers to cover weight-loss surgery, an effort that could give millions more obese Americans access to the treatments.

Advocates say it will give obese patients a complete arsenal for fighting the condition that can spur a host of life-threatening illnesses and help save billions of dollars in healthcare costs for employers and the government.

Critics argue that bariatric surgery has high rates of complications and that, ultimately, surgery does not change the behavior underlying obesity.

One of the most vocal manufacturers is Allergan Inc, the maker of Botox and breast implants. The company wants to revive weak sales of its LapBand, a silicone cuff that is implanted around the top portion of the stomach to constrict food intake.

"It's all about reimbursements," Allergan Chief Executive David Pyott told Reuters. The benefits of weight loss surgery, he added, "are not well understood by policy makers."

Allergan recently beefed up its staff working on securing reimbursement for LapBand to more than 100 people from seven.

Pyott is spending more time in Washington D.C. speaking with officials at the U.S. Department of Health and Human Services, as well as with lawmakers about having bariatric surgery included in the package of standard benefits that all insurance plans must offer under the 2010 Affordable Care Act health system overhaul.

LapBand competes with a device called Realize made by Johnson & Johnson, which says it is also working toward better reimbursement.

Gastric banding is only one type of bariatric surgery. Others are more complicated, involving stapling portions of the stomach to limit food intake or re-routing the path of digestion, limiting calorie absorption. As with any major surgery, all carry the risk of complications and infection.

Allergan is pushing for coverage for all bariatric surgery, including methods that compete with its LapBand device, because it is more likely that private and public insurers would approve the entire category.

The company says some private insurers have changed their policies as a result. For example, the Midwest Blue Cross/Blue Shield Plan and the Health Alliance Medical Plan in Southern Illinois and Iowa recently eliminated the requirement that a patient must have tried and failed to lose weight under the supervision of a physician before getting surgery.

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COSTS IN THE BILLIONS

Nearly 73 million Americans are considered obese, defined as having a ratio of weight to height, or Body Mass Index (BMI), of more than 30. For example, a 5'9" adult weighing more than 203 pounds is consider obese. About 12 million people are classified as morbidly obese, defined as having a BMI over 40.