Why would a health insurance company not want to pay for something that will save them money in the long run, even if they have to pay in the short run (for example weight loss surgery)?

We’re asking why anything insurance companies do makes sense?

They’re a company that profits off taking money from people that can’t afford it, and telling those same people they don’t deserve to be treated for their illnesses. They are, indeed, the scum of the universe.

This is a complicated issue right now. I am not sure which surgery your friend is looking into, but part of the reason they aren’t all covered is there isn’t a consensus about which one is best.

When it comes to why most of these companies do what they do, it is very frquently about their bottom line not yours.

Why spend money in the present when the person might die before any money is spent?

People change health insurance plans quite often. They always move towards a cheaper plan. So an insurance company that invests in preventive health care is likely not to receive the benefit for it’s investment. In a marketplace environment for health insurance, providing preventive care works only if you can hold onto a person for a long time.

So instead of providing preventive care, insurance companies seek to minimize their expenses by denying everything they can. This is but one of the many problems of a supposedly competitive health insurance market.

It is one more reason why the only solution is a single payer system. Only a single payer system would benefit from improving people’s health over the long term. Only a single payer system would benefit from the savings. In a competitive system, it is a race to the bottom—who can deny the most care while maximizing premiums.

You don’t need weight loss surgery. Sure, it may help down the road. But it isn’t something that has to happen most of the time.

Everyone else gave good reasons so far, another thing to take into consideration is that the surgery is not guaranteed to work. Weight loss surgery is a huge commitment and requires a major lifestyle change. There are still a decent number of people that have the surgery and it is not successful for them.

I’ve dealt with insurance companies a few different times trying to get them to cover the surgeries and it seems like the most of them will only cover it is the person also has sleep apnea and at that point it becomes a more necessary procedure because of the dangers of sleep apnea.

Maybe they figure the surgery isn’t required. The individual needs a lifestyle change which would cost nothing and actually save her money. That is easier said than done but is still possible..

It would be interesting if we could see the data about the survivability of illnesses across insurance companies the way we see it across treatments.

“Gall Bladder cancer patients have a 5 year expected life with company A and a 7 year expected life with company B”.

With that information out there, insurance companies might have more reason to address health issues instead of only addressing saleability and cost issues.

Wow, @6rant6! That would be so interesting. If there were no differences, what do you think that would mean? If there were differences, what theories do you think you might come up with to explain that?

I know I’m asking a lot, but if you could just throw a few ideas (or even one) out, I think that would be really interesting. Wow! This seems so obvious. Surely someone has looked at it.

Because it is hard to determine between gluttons and individuals with real health issues.

One of the most important things to konw about large corporations is that most of the higher level managers are products of major ivy leage schools. In those schools they teach that maximizing profit is the be-all and end-all of business. Therefore, we wind up with most CEOs and high level managers being paid based on quarterly profit margins. This extreme focus on bottom line, quarterly results has a number of darwbacks, not the least of which is an almost total disregard of the future success of the company. The attitude is: “I’m getting a great bonus because of the quarterly profit margins while I’m in charge. Let those runing the company after I retire figure out how to do the same!”

Weight loss surgery is considered optional. It does not have a good track record. It still all comes down to DNA, Diet, and Exersize and two of those are not affected by the surgery.

Presumably, they could save even more money if you and your friend would lose weight the old-fashioned way.

Although, I am in awe of @worriedguy’s simple response, and should just walk away, as all that really needs to be said has been said there, I will add that I think it’s important to note the data mining aspect, where there are certain meta level realities that transgress individual level logic. For example: say you have two families effectively exactly the same from an insurance company point of view. One family’s child incurs a fractured arm from a triple back flip on a snowboard that costs 10,000 dollars. The second family submits a $400 bill from an acne specialist.

Only the second family’s insurance goes up.

WTF? How can the $400 expense increase rates when a much more expensive broken arm does not? Surely the athletic kid is more of a risk than my sweet little book worm!

What happens is that analysts segment customer’s data into certain risk “buckets”. It may very well be the case that a broken arm – statistically – correlates to a lower total spend, whereas an acne case correlates to a host of future spend. I made that example up, but I assure you there are countless real world examples that would defy simple logic.

So being “self conscious” of aesthetics may statistically imply other surgical procedures that a patient might want to undergo, whereas the person who only goes to the doctor for an actual broken bone is much more “predictable”.

Your question is a great example. Your friend’s interest in the procedure is influencing your interest. The decision to spend on her statistically includes your potential spend as well. Very different than how broken bones work.

So the issue we face is not specific to free market insurance companies. It applies to home lending, to single payer insurance companies in France, to what products are available in the supermarket, to what government spends on anything, any number of situations where the spend is “data driven”, ultimately dehumanizing case-by-case examples.

@Nullo yeah.. either just diet the old fashion way, or die of a massive coronary. Life expectancy is not good for obese people. Insurance are less likely to support a really long illness in an obese person. I worked for an insurance company and they asked weight and height. Once it hit a certain ratio…. they weren’t covered for a bunch of stuff.

@cazzie You’d think that a person’s sense of self-preservation would kick in at some point, but it usually doesn’t.

They probably use the same type of Actuarial Tables that Life Insurance companies use to determine the cost effectiveness of their coverage.

I’ve never understood this with respect to birth control. Why some insurance policies refuse to cover contraception or abortion is beyond me, considering the increased cost of having a child on a policy.

Why won’t they pay for preventative care? Because they have no intention of paying when the “insured” is sick, either. They have no intention of paying anything, period. Scum of the universe is right!

@Nullo There are people that eat right and exercise and still have enough weight to lead to heart issues, diabetes, and other obesity-related ailments. Some people are truly fighting genetics or other ingrained things and cannot lose weight through lifestyle changes alone.

They report profits quarterly.

@Mamradpivo Whether or not to have kids is a another hot topic. Most of the medical world views allowing a woman to decide what to do with her body in that regard as totally her choice. When insurance companies hear that word, then a whole different algorhythm kicks in. The flip side of that is if you are going to pay to help some prevent having children who are chosing not to, then do you have to pay to help for anyone who wants to have a child.

Not my views here just some food for thought.