State Of Wisconsin To Cover Weight-Loss Surgery For Workers

Starting in 2020, the state of Wisconsin will start paying for weight-loss surgery, leaving only a handful of states in the country that don’t cover the procedure.

In recent years, some private insurers in Wisconsin like Dean Health Plan and Quartz Health Solutions have also decided to cover the surgery or offer it as a rider to their health policy.

“I’m a big believer in making it available to patients,” said Melina Kambitsi, who had bariatric surgery 10 years ago when she was taking two medications for her diabetes. Since then, she has gained some of the weight back, but said her blood sugar is under control.

Prior to having surgery in Pennsylvania before moving to Madison for a job as a health insurance executive, Kambitsi said she tried dieting, acupuncture and working out.

“It’s an important component. But unfortunately, where people fail is really their intake,” said Kambitsi, explaining that many people underestimate the amount of food they eat and being active can’t always counteract that.

Public employees who are in the state Group Health Insurance Plan and have a body mass index (BMI) of 35 or greater would be eligible for bariatric surgery. Health plans could cover those with a lower BMI if the procedure is medically necessary. The agency which oversees benefits, the Department of Employee Trust Funds, estimates that nearly 6 percent of public workers are obese and nearly half have a medical condition associated with obesity, like diabetes, high blood pressure, osteoarthritis and heart problems.

Dr. Luke Funk has done research on obesity in Wisconsin, which has been going up in recent years. Most concerning, he said, is that obesity is going up fastest in young adults — a trend seen nationwide.

Historically, a lack of insurance has been a major barrier for patients, said Funk, who’s an assistant professor of surgery at the University of Wisconsin-Madison School of Medicine and Public Health.

A consultant for the state Department of Employee Trust Funds predicted not all public workers with a high BMI would want weight-loss surgery, but the additional cost in claims for those who did seek treatment would be between $1 million to $3 million.

Kambitsi said she hopes the state’s action will prompt more employers in Wisconsin to consider changing their benefit plans to include bariatric surgery.

“Many of the self-funded employers are not covering bariatric surgery and yet they spend a lot of money on wellness,” she said.

Last year, The Alliance where Kambitsi works, held a wellness forum for companies urging them to consider covering weight-loss surgery.