SurgeryPlus and Transcarent are both companies that offer great potential to increase access to bariatric surgery in the US. Patients who suffer from obesity are often faced with some important decisions to make regarding weight loss surgery. Nothing is more frustrating though, than choosing to go forward with a life-saving bariatric procedure only to find out that your insurance doesn’t cover it. Employers are also faced with a challenge to keep healthcare costs low, which can lead them to the uneducated decision to exclude weight loss surgery. The good news is that there is a ray of hope for some folks out there, and that is Employer Direct Healthcare (EDH). This is a newer trend in the US, which can allow employees to have access to weight loss surgery, while still keeping costs low for employers.
Unlike traditional insurance, employers can contract directly with EDH companies such as SurgeryPlus and Transcarent for specific carve-outs like weight loss surgery. These two companies have already done the heavy lifting of searching out a number of surgeons and facilities that are cost-effective for the employer, but also offer great quality to the patient. Typically, employees who choose to have a bariatric surgery through SurgeryPlus or Transcarent will have no out-of-pocket expense, and in some cases can even be reimbursed for any travel expenses involved. In addition to no out-of-pocket cost, many of the barriers are removed for patients so that they can have surgery in 4-6 weeks, instead of the usual 4-6 months!
We are proud to be the SurgeryPlus and Transcarent facility and surgeons for Ohio, Kentucky, Indiana, Michigan, Pennsylvania, Tennessee, West Virginia, and Virginia. Hopefully EDH will become more prevalent with time, and access to care for much-needed weight loss surgery can be greatly expanded. As it currently stands, it’s estimated that in the US only around 1% of patients who need weight loss surgery actually have a plan that will cover it.
SurgeryPlus and Transcarent are contracting with more and more employers every month, so be sure to check your benefits to see if it’s offered at your company. If it’s not, contact your HR department and let them know that it’s something they should look in to!
- CVS Health (includes all Aetna employees)
- Delta Airlines