So what’s the problem? People who want lap-band surgery can now obtain it, and get it covered by insurance. No big deal, seemingly. Until you dig a little deeper to see who is behind this push, like the LA Times did:
The people behind TopSurgeons are the Omidi brothers — Julian, whose medical license was revoked in 2009, and Michael, who was placed on three years’ probation for gross negligence in 2008,according to the Medical Board of California.
* The inspectors found unsanitary conditions in the surgical areas. Medications and supplies to treat complications from anesthesia were expired or missing, though 23 patients were waiting for surgery.
* Surgical instruments weren’t being properly disinfected. Medical supplies that were supposed to have been tossed after use on a single patient were being reused. Two employees had positive tests for tuberculosis, but there was no record that they got required follow-up chest X-rays.
* The crash cart, which carries equipment and supplies for cardiac emergencies, contained opened and expired drugs and supplies, including some more than 4 years old. Other drugs and supplies, including emergency drugs, were months or years past expiration. Filled and inadequately labeled syringes were found in the operating room. Most of the scrub sinks weren’t working.
* Patient records, which contain such confidential information as psychological exams, were left where unauthorized people could read them.
Um, wow! That sounds like a safe and well-organized and overseen place to undergo major surgery under general anesthesia! But at least the people who are undergoing surgery really need it and it will significantly benefit their health, right? Well, no, says the LA Times:
Medical guidelines endorsed by the National Institutes of Health say the prime candidates for the lap-band are morbidly obese patients, defined as those with a body mass index — a comparison of weight and height — of 40 and above. (A 5-foot-10 person would register a 40 BMI at 279 pounds, or about 100 pounds overweight.) Patients with a BMI of 35 (244 pounds for our 5-10 subject) would be candidates if they also had weight-related conditions such as diabetes.
The patient selection principles of TopSurgeons seem to be rather liberal. Its website says it “can help those with a BMI of 27 or greater.” (For our 5-10 patient, that’s a threshold of 188 pounds.)
There are two problems with those broad patient selection rules. First, patients who do not really qualify for the procedure and who are not expected to benefit from it are undergoing major and potentially life-threatening surgery for no good reason. Second, the insurance companies base payment off those NIH criteria, so are not likely to pay for surgery for those folks who opt for surgery but do not meet the NIH guidelines. Given the marketing push, the tie to fat shaming, and the extremely liberal acceptance guidelines of these doctors, a majority of their patients are likely to be considered “voluntary” and thus not eligible for insurance coverage of the surgery.
This surgery costs around $18,000. So if insurance isn’t paying for it, who does? Most of the people targeted by these billboards and ads are low-income and predominantly Spanish-speaking, so don’t just have $18,000 in their checking accounts to pay for this surgery. Instead, they’re offered credit lines to cover the cost of the surgery – and charged 13.9% interest on the costs.
That kind of predatory lending would be bad enough if it were limited to people who actually opted to undergo the surgery. But the entire operation seems to be an effort to get people to sign up for financing:
According to Nancy Wambaa, a 51-year-old Los Angeles woman, TopSurgeons “encouraged” her during an office visit last year to fill out an application for the card just to check her credit. A full-time student and Medi-Cal enrollee, she was surprised to be told within hours that she’d been approved, and even more surprised a month later to get a bill for $15,000 from GE, even though she had told TopSurgeons that on her doctor’s advice she had decided against the surgery.
TopSurgeons eventually refunded $12,000 but kept $3,000 as a “cancellation fee.” She sued the Omidi brothers in state court Aug. 20, 2009, alleging breach of contract, breach of fiduciary duty and violation of the state consumer protection law. The court file indicates that they never answered her lawsuit, and in December she won a default judgment for the money.
Nothing like being billed $15,000 at 13.9% interest for a medical procedure you did not sign up for and for which you had no actual medical need!