Tuesday, July 5, 2011

BCBSNC to cover sleeve gastrectomies

Beginning July 1, 2011, BCBSNC will cover the sleeve gastrectomy procedure for qualified members who meet the criteria outlined in their medical policy titled “Surgery for Morbid Obesity.” You can search the medical policy on http://www.bcbsnc.com/.

What is a sleeve gastrectomy?
A sleeve gastrectomy is an alternative approach to a standard gastrectomy that can be performed on its own or in combination with other procedures. In this procedure, a portion of the stomach is removed, leaving a stomach remnant shaped like a tube or sleeve. Additionally, the pyloric sphincter is preserved, resulting in a more normal transit of food from the stomach to the duodenum and avoiding some of the complications seen with other gastrectomy procedures. A sleeve gastrectomy procedure is relatively simple to perform, and can be done through an open or laparoscopic technique.

Who might undergo this procedure?
As stated in the medical policy, a member must have a body mass index greater than 40 or over 35 along with one or more co-morbid conditions. Also, the surgery must be part of a comprehensive pre-surgical, surgical and post-surgical program. Some surgeons have proposed this as the first in a two-stage procedure for very high-risk patients.

Why has BCBSNC decided to cover this procedure?
Previously, this procedure was considered investigational. Now, long-term follow-up data (up to six years after surgery) and comparative studies are available. The research shows resulting extensive weight loss. Weight loss following a sleeve gastrectomy may improve a patient’s overall medical status and, as a result, reduce the risk of a subsequent, more extensive procedure. It should be noted that as with other surgical weight-loss procedures, weight gain often recurs over time.

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