Two Major Insurers Now Cover Laparoscopic Sleeve Gastrectomy

The American Society for Metabolic and Bariatric Surgery (ASMBS) today announced its support of recent policy changes by Aetna Inc. and United Healthcare. The national health insurance giants will now cover laparoscopic sleeve gastrectomy, a newer method of bariatric surgery that is becoming increasingly popular as a treatment for morbid obesity.

"We are pleased that Aetna and United Healthcare now includes sleeve gastrectomy among its covered bariatric procedures," said John W. Baker, MD, FACS, President of ASMBS. "In the rapidly changing field of bariatric and metabolic surgery, it is important to provide coverage and access to a wide range of proven treatment methods. Sleeve gastrectomy has now reached that threshold where the data and our experience with the procedure supports its safe and effective use in people affected by the chronic disease of morbid obesity."

The ASMBS first issued a position statement on sleeve gastrectomy in 2007, but updated it in November 2009 after the peer-reviewed publication of new data and the increasing use of the procedure.

In sleeve gastrectomy, the stomach is surgically reduced to a thin, vertical sleeve that is about 15 percent of the original size of the stomach. Patients feel full faster and consume less, which results in significant weight loss and improved health.

Prior the policy change, Aetna and United Healthcare classified sleeve gastrectomy as „investigational‟ and would not cover the procedure. Aetna began covering the procedure this month and United Healthcare began in October 2009. Other bariatric procedures covered by these and many insurers include Roux-en-Y Gastric Bypass, Laparoscopic Adjustable Gastric Banding and Biliopancreatic Diversion with Duodenal Switch.

“We will continue to work with the medical community and coverage providers to improve access to bariatric and metabolic surgery so that we can more effectively meet the needs of patients,” said Robin Blackstone, MD, FACS, Chairman of Access to Care Committee, ASMBS. “We hope other insurers will follow the lead of Aetna and United Healthcare and expand coverage to include sleeve gastrectomy as a medically necessary treatment option.”

Dr. Blackstone says the ASMBS will continue working to improve access to care for bariatric and metabolic surgical procedures that eliminate, resolve or improve obesity-related diseases like the remission of Type 2 diabetes, hypertension and sleep apnea.

Last year, the ASMBS joined with the Society for Alimentary Gastrointestinal and Endoscopic Surgery (SAGES) to request a procedure code from the American Medical Association (AMA). The requested was granted and a code (CPT 43775) was established for use on January 1, 2010. Procedure codes are used by insurers to identify surgical, medical or diagnostic services and to determine coverage and reimbursement.

Bariatric surgery is indicated for adults who have a body mass index (BMI) of 40 or higher or have a BMI of 35 accompanied by an obesity-related condition such as Type 2 diabetes or hypertension.