Question:
BC/BS of Florida has announced it will stop covering gastric bypass

On cnn.com The Jacksonville-based company says safety is the main reason it will drop the $30,000- surgery, also known as stomach stapling, which is considered a last resort for morbidly obese people trying to lose weight. Dr. Robert Forster, the company's chief medical officer and vice president for health care services, said about three in every 1,000 patients die and up to 20 percent of patients return to the hospital for a second procedure. There has also been a spike in demand for the surgery, which would have cost the insurer about $200 million over the next few years and could have lead to higher premiums, Forster said. The surgery's popularity has grown because of the success that celebrities, such as television weatherman Al Roker and singer Carnie Wilson, have had with it. That has prompted commercialization and the spread of information -- on the Internet, radio and elsewhere -- on how to get around strict guidelines as to who can safely undergo the surgery, Forster said. Doctors with limited experience also are jumping on the bandwagon to take advantage of the high demand, he said. Forster acknowledged successful surgery reduces other health problems such as diabetes, but he said some patients encounter new problems. About 30 percent of patients develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease, according to the National Institutes of Health. Dr. Anthony Terracina, who specializes in the surgery, said he is no longer accepting patients at Surgical Associates of Northwest Florida and will leave the state in June because the surgery is cost-prohibitive without insurance coverage for most people. He plans to relocate to Hampton Roads, Virginia, because Virginia law requires insurers to cover the surgery. "It just doesn't make any sense that the insurance companies would do this," Terracina said. "Obesity is the No. 1 health problem in the United States. Why wouldn't you help those patients and keep them out of the hospital?"    — jengrz (posted on March 3, 2004)

March 3, 2004
You know, someone at our monthly support group brought up this and a study she heard that said two years out and the surgery is proven not to work. I'd like to explain something. First, as for doctors, you are advised to check out the histor and credentials of any surgeon you chose. That's you're right. But as for insurance coverage, let me tell you this. I have been practicing insurance law since before even law school. When the MRI was invented I watched lawyers I worked for in College become rich because they had a way to show injuries from accidents. Years later when the insurance companies couldnt win anymore they took another route. They spent and continue to spend millions of dollars on so called studies and tests to prove these MRI's and other tests really don't show anything. I can't tell you how many trials proceed here in New York with two doctors each saying they see something different. I explained at our group last nite. These companies are losing appeals. In States like New York and virginia the surgery must be covered if its medically necessary even if its excluded. In other States, patients and we lawyers have been overturning appeals and winning the right to surgery for our clients. So, what is going to happen is that alot of "studies" and tests are going to be floating out in the public to "prove" that this surgery doesnt work, that it fails, that we grow horns after 3 years and turn into goats. Whatever they can to force States and the government to stop the flood of surgeries because they cannot do it legally right now. So, be positive. Continue fighting and do what's best for you. Don't let these companies dictate your life.
   — gary viscio