TOPLINE

A secret shopper study of 35 metabolic and bariatric surgery programs in North and South Carolina found that administrative, not insurance, barriers were the main obstacles to booking initial consultations — including repeated call attempts, inaccurate contact information, and multiple preappointment requirements. Nearly a third of the centers couldn't be contacted at all, and a notable number of centers required following extra steps such as filling an online application or attending a seminar before scheduling.

METHODOLOGY

• Bariatric surgery is the most effective treatment for obesity, which affects a notable proportion of US adults, yet long wait times, stigma, fear, and insurance restrictions keep it drastically underused.
• Researchers conducted a secret shopper study of 35 bariatric surgery centers in North Carolina (n = 18) and South Carolina (n = 17) from June to August 2025 to investigate appointment accessibility and program requirements for patients seeking surgery.
• Trained callers made two scripted calls to each center in a random order, posing once as a patient with Medicaid and once as a patient with private insurance, to request an initial consultation appointment.
• Information collected included appointment wait times, documentation requirements, presurgical prerequisites, and administrative barriers.
• An access barrier was recorded if a program's contact information was incorrect or nonfunctional or if it could not be reached after three attempts on different days.

TAKEAWAY

• Overall, 24 out of 35 centers (68.6%) were successfully contacted by phone; 11 centers (31.4%) could not be contacted despite multiple attempts, with as many as nine centers having incorrect contact information.
• All contacted centers accepted private insurance and 94.3% accepted Medicaid. The median wait time for the initial appointment was 20 days, with no difference by insurance type. Programs required an average of 1.7 calls to reach a scheduler.
• A total of 27 centers required carrying out preappointment steps — online applications (16 centers), seminar attendance (10 centers), primary care referrals (nine centers), or screening questionnaires (seven centers).
• Of the 24 centers that could be contacted, eight required the completion of two or more steps before an appointment could be scheduled.

IN PRACTICE

"Metabolic and bariatric surgery centers should work to streamline the process of getting patients into their clinics, and analyze how their practice may be creating barriers to care for these patients. Patients face enough barriers without their own healthcare providers creating more," the authors wrote.

SOURCE

The study was led by Rylee Barber, Medical University of South Carolina, Charleston, South Carolina. It was published online in Obesity Surgery.

LIMITATIONS

No limitations were explicitly mentioned in the study.

DISCLOSURES

No specific funding was reported. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.