Article1 min read·Published Sep 2014Older

Access to care for adolescents seeking weight loss surgery

Part of Adolescent Bariatric Surgery 39 items

pubmed.ncbi.nlm.nih.gov

Michael Helmrath

Objective: Adolescents seeking weight loss surgery (WLS) frequently encounter obstacles obtaining treatment authorization from insurance carriers. This study identified factors influencing authorization for adolescents with clinical indications for WLS. Methods: A retrospective review was conducted for adolescents with clinical indications for WLS at five adolescent centers. This cohort represented a consecutive series of adolescents with insurance benefits for WLS for whom insurance authorization was sought between 2009 and 2011. Outcomes included number and timing of insurance authorizations for surgery, denials, and appeals. Results: Records from 57 adolescents (74% female; mean age 16 (range: 12-17) years; mean BMI 51.3 kg/m(2) ) were reviewed. Of these, only 47% were approved with the original request. Eighty percent of those denied were approved on appeal, while 11% never obtained authorization for surgery. Age less than 18 years and proposed procedure were the most common reasons for denial. Conclusions: Less than half of adolescents with clinical indications for surgery received approval for the procedure on the first request. The appeal process typically resulted in overturning of denials, so that surgical care could be delivered.

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Article · Sep 2014 · 1 min read

In brief

This multi-center study reveals that only 47% of clinically eligible adolescents receive initial insurance approval for bariatric surgery, with age under 18 and procedure type being primary denial reasons. While 80% of denials are overturned on appeal, the authorization process creates significant barriers to timely surgical care for severely obese adolescents.

Written by the GCMD Library team from the article.

Michael Helmrath

Statements in this article

Only 47% of adolescents with clinical indications for weight loss surgery were approved with the original insurance authorization request.
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Eighty percent of adolescents denied initial authorization for weight loss surgery were approved on appeal.
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Eleven percent of adolescents with clinical indications for weight loss surgery never obtained insurance authorization.
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Age less than 18 years was one of the most common reasons for insurance denial of weight loss surgery.
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The proposed surgical procedure was one of the most common reasons for insurance denial of weight loss surgery in adolescents.
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