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Louisiana’s health insurance plans that cover state workers and public school teachers will now help pay for weight-loss surgeries that people had previously had to cover out of their own pockets.
Gov. John Bel Edwards signed into law Senate Bill 150, sponsored by Sen. Regina Barrow (D-Baton Rouge), to provide weight-loss surgery coverage to people with state health insurance — including retirees — last week. It goes into effect Aug. 1.
A patient must be in a state health insurance plan for at least one year before accessing the benefit. There are approximately 124,300 people in the state’s five health insurance plans, according to the state’s legislative fiscal office.
Hospitals and LSU’s Pennington Biomedical Research Center — which studies the health effects of obesity — pushed for the new law.
Louisiana has one of the highest rates of obesity in the country and researchers say weight-loss surgery is one of the most effective methods for treating it, but few people in Louisiana can afford to pay for surgery out of pocket. Louisiana is also one of only five states where the state health insurance plan doesn’t cover weight-loss surgery already, advocates said.
Hospital systems are hoping that the state’s decision to cover weight-loss surgery will encourage private employers in the state to do the same.
To qualify, the person must have a body mass index of at least 40 or a body mass index of at least 35 with two other morbidities, according to the new state law. The state health plan will not cover the removal of excess skin, a common problem for people with dramatic weight loss.
Legislative staff estimates that 29,132 people enrolled in state health insurance plans meet the current criteria for the surgery, though only a fraction of these people will have access to insurance coverage for the surgery annually. In order to keep costs down, Louisiana is limiting coverage to 300 weight-loss procedures per year.
Even with that restriction, the new law is expected to cost Louisiana $5.7 million in the next fiscal cycle. Expenses are will go down over time — as people’s post-surgery health improves and they don’t need other types of medical treatment. By the 2025-2025 fiscal cycle, weight-loss surgery should only cost Louisiana $2.3 million, according to the latest fiscal estimates.
Patients will have to cover some costs for the surgeries out-of-pocket as well. They will be responsible for 20 percent of the preoperative services, $2,500 for the surgery itself and an additional 10 percent of the remaining cost of the surgery. Rates for all people covered by state health insurance plans — whether using weight-loss surgery or not — are expected to go up by $4 per month as a result of the next benefit, according to the legislative fiscal office.
The total cost of weight-loss surgery is estimated to be around $24,000 — including preoperative care, according to the legislative fiscal office. Thirteen medical centers around the state are authorized to offer the procedure.
State Rep. Robby Carter, D-Amite, said during a hearing on this legislation that he had the surgery a few years ago and lost 60 pounds as a result. Carter said the surgery improved his health. He said he had a cousin who also got the surgery and is living a much fuller, more active life.
But the cost of the surgery has been a barrier to people getting coverage, according to Carter, He said he knows of approximately 20 people who went to Mexico — where weight-loss surgery is cheaper — to have the procedure done because it was so expensive in the United States.
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