WLS and HMOs

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Heywood Mogroot - 10 Aug 2004 00:50 GMT

Somewhat recently someone brought up the point that WLS couldn't be so
bad an option since HMOs were beginning to cover it.

I didn't have an answer then but I thought of one now...

HMO's primary priority is controlling costs, and the patient's health
really has nothing to do with it. It could indeed be cheaper to the
HMO for the morbidly obese to undergo the surgery and suffer through
the horrific but intentional degradation of the digestive tract,
rather than for the HMO to pay for associated health costs of the
morbidly obese.

That 1-3% of WLS patients die on the table or in post-op is most
likely a net-win for the HMOs, too.

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Dally - 10 Aug 2004 03:04 GMT

> Somewhat recently someone brought up the point that WLS couldn't be so
> bad an option since HMOs were beginning to cover it.

Are HMOs starting to cover it? My understanding is that the
complication rate (20% need follow-up surgery) combined with the weight
regain (a fair number still regain the weight) combined with the
mortality rate (I'm in New England where quite a few people have died)
have all brought it into sharp focus: now the HMOs want it studied for
efficacy.

> That 1-3% of WLS patients die on the table or in post-op is most
> likely a net-win for the HMOs, too.

Good point. It might be a consideration.

Dally

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