Laparoscopic Sleeve Gastrectomy Insurance Coverage
After previously classifying the laparoscopic sleeve gastrectomy as “investigational” and refusing to cover the procedure, Aetna and United Healthcare have announced new policy changes reversing their earlier decision and covering the procedure.
Sleeve gastrectomy, a newer method of bariatric surgery, involves reducing the stomach to a thin, vertical sleeve that reduces the size of the original stomach by more than 85%. Patients who undergo the procedure will feel full quicker and eat less, which should result in weight loss.
In addition to sleeve gastrectomy, Aetna and United Healthcare also cover bariatric procedures that are covered by other insurers, such as Roux-en-Y Gastric Bypass, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic Diversion with Duodenal Switch.
Adult patients are usually considered viable candidates for bariatric surgery when they have a body mass index (BMI) of 40 or higher, or have a BMI of 35 accompanied by an obesity-related condition such as hypertension or diabetes.
The American Society for Metabolic and Bariatric Surgery (ASMBS) supports these recent policy changes. “In the rapidly changing field of bariatric and metabolic surgery, it’s 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,” said John W. Baker, MD, FACS, President of the ASMBS. The ASMBS also encourages other insurers to follow the lead of Aetna and United Healthcare and improve access to bariatric and metabolic procedures.