County's insurance covers weight-loss surgery
April 1, 2013 at 11:01 p.m.
Updated April 1, 2013 at 11:02 p.m.
After battling weight all his life, Ron Pray decided to do something drastic.
At 560 pounds, he was considered super morbidly obese. He was on five blood pressure medications, was pre-diabetic and ready to have heart congestion.
"I would be dead in 10 years," he said. "That's all changed."
Six months ago, he took out a loan to pay for gastric sleeve surgery, which costs upward of $15,000. As an employee of Victoria County, none of the costs were covered.
"I had to basically buy a car to lose weight," Pray, the Victoria County fire marshal, said.
He knows to some degree that people consider the surgery cosmetic. In his case, he says it was life or death.
On Monday, Victoria County Commissioners approved reinstating bariatric services to its employee health care package.
"I think it's something the employees need," Pray said. "Not just for frivolous weight loss, but for some people who have genetic issues, like I do, it's very difficult, and I've struggled my whole life."
Since the surgery, Pray has lost 170 pounds and was able to get off all his medications, except for vitamins.
"I'd pay it again tomorrow because it's changed my life," Pray said.
Under the revised plan, employees would pay an additional $3,500 deductible, and the plan would be responsible for 80 percent of the bill.
County Administrative Services Director Joyce Dean said the surgery would be offered only once to eligible people. The surgery will not be covered for "normal weight loss."
She said the surgery falls in line with the Affordable Care Act, which favors preventative treatment.
While it is believed to reduce long-term health costs, several studies say otherwise.
A 2012 study from the National Institutes of Health found bariatric surgery does not appear to be associated with reduced health care expenditures three years after the procedure.
However, the undeniable health benefits make it a valuable option for treating extremely obese patients.
County Judge Don Pozzi said the bariatric services were taken out of the county insurance program five or six years ago.
"I was convinced at that time after looking at the statistics that it was being misused," Pozzi said.
Unless lifestyle changes are made, the surgery can be a waste of time and money.
"The success rate is not much better than it previously was," Pozzi said.
Pozzi said he was in favor of restoring the service to the insurance plan.
Although Commissioner Danny Garcia said he was hesitant to pick up the expense, Pray's story, which he shared during the commissioners court meeting, changed his mind.
The issue passed unanimously.
"Based on everything we've heard, I think we need to take a chance on it," Commissioner Gary Burns said.
The revised insurance program also waives a $500 additional copay for emergency room visits if the visit is deemed an "emergency" and if the patient is referred to the ER by the county employee clinic.
Pray said he can now walk comfortably from the parking lot and up the stairs of the courthouse to the county commissioners' meetings without needing to catch his breath.
"I can do my job better," he said.