P4093 - Real-World Experience With Insurance Coverage for Endoscopic Bariatric Therapies: A Cross-Sectional Analysis From a Large Academic Medical Center

Sagar Shah, MD¹, Firas Bahdi, MD², Philip Kozan, MD¹, Stephen Kim, MD¹, Alireza Sedarat, MD¹, Erik Dutson, MD¹, Adarsh Thaker, MD¹, V. Raman Muthusamy, MD, MAS¹, Danny Issa, MD^1
1UCLA, Los Angeles, CA; ²David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA

Introduction: Despite substantial evidence for the safety and efficacy of endoscopic bariatric therapy (EBT) for weight loss, insurance coverage remains remarkably limited in the United States. Insurance reimbursement is an important determinant of patients’ access to care, as well as physicians’ compensation. We aimed to identify demographic, clinical, and procedural factors associated with insurance coverage for patients undergoing EBT.

Methods: We performed a retrospective review of patients who underwent EBT for the treatment of obesity at a tertiary-care referral center between Jan 2020 and May 2023. All patients who received insurance coverage were included. Cash-pay patients were excluded. A control cohort of eligible patients denied by insurance was studied. The primary objective was to identify predictors for successful prior authorization and coverage. Secondary outcomes included the proportion of procedural costs covered by insurance.

Results: A total of 158 patients were included (124 successfully received insurance coverage for EBT, and 34 controls with denied prior authorization) (Table 1). Among commercially available insurers, percentage of patients insured with Blue Shield (P< 0.0001) and Cigna Healthcare (P= 0.03) were significantly lower in the covered group compared to the denied authorization group {7% vs 38.2%, 1.6% vs 8.8%; respectively). No difference was found in the insurance coverage rate based on BMI > 30 kg/m2 alone, BMI >30 kg/m2 + 1 comorbidity, BMI 30 kg/m2 + 2 comorbidities, presence of diabetes, age, or gender. Significantly greater coverage was seen for patients undergoing revisional procedures compared to primary EBT (87.1% vs. 18.5%, respectively; P< 0.001). In a subgroup analysis performed for 57 ESG patients (Table 1), Cigna Healthcare had the lowest approval rate; however, no predictive clinical or demographic factors were found to predict better insurance approval for ESG.

Discussion: Revisional endoscopic procedures received better insurance coverage than primary endoscopic therapy. Although we identified two commercial insurers more frequently denied coverage in our cohort, no other predictive factors could be determined. These results indicate a lack of standardization and the state of outdated insurance policies that do not reflect the current efficacy data for ESG. As the need for less-invasive treatments for obesity grows larger, so does the critical appeal for expanded, transparent coverage of these treatments.


Disclosures:


Sagar Shah, MD¹, Firas Bahdi, MD², Philip Kozan, MD¹, Stephen Kim, MD¹, Alireza Sedarat, MD¹, Erik Dutson, MD¹, Adarsh Thaker, MD¹, V. Raman Muthusamy, MD, MAS¹, Danny Issa, MD¹. P4093 - Real-World Experience With Insurance Coverage for Endoscopic Bariatric Therapies: A Cross-Sectional Analysis From a Large Academic Medical Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.