Medicare Bariatric Surgery: Medicare Creates Coverage for Obesity Surgery      

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In February 2006, Medicare announced that it would cover bariatric surgery, which is surgery used to treat obesity.  Three different types of surgeries are covered:  The Roux-enY bypass, which creates a small pouch in the stomach to connect to the bowel in order to bypass most of the stomach; open and laparoscopic biliopancreatic diversions to bypass most of the small intestine and pancreas, and laparoscopic adjustable gastric banding, which pinches off part of the stomach.

Obesity rates in America are extremely high, according to experts.  Statistics show that approximately 65% of American adults are now overweight.  This has now become a national epidemic, as obesity increases the risk of heart disease, diabetes, cancer and other complications.  Americans are turning more and more to bariatric surgery. 

It used to be that Medicare only covered bariatric surgery if it was needed to correct an illness caused by or exacerbated by obesity.  There was no national coverage policy, so each state had its own.  Now, there is a uniform policy, which covers all Medicare recipients for the surgery.  The Centers for Medicaid and Medicare Services no longer require patients to try other weight-loss treatments first, as most have already made several attempts to lose weight.  To qualify, their body mass index must be over 35 and they must suffer from other weight-related issues such as diabetes or heart disease.  In addition, the surgery must be performed at a medical center approved by the American Society for Bariatric Surgery, or at a certified Level 1 Bariatric Surgery Center by the American College of Surgeons.

Advocates of the new provision claim that covering the surgery will reduce Medicare costs, as patients recover from their obesity-related health problems.  The agency estimates that the new procedure will cost less than expenses associated with heart disease, such as coronary bypass and defibrillators.  It is expected that the patients’ health will improve after surgery, and they may even be able to go off disability.  ASBS President Neil Hutcher, MD says that Medicare coverage for bariatric surgery will begin to remove the stigma of obesity and gastric-bypass surgery, and will cause private health insurance providers to follow suit.

Entry Filed under: For Medicare Providers, General-Medicare