Two health insurers have recently added a new type of bariatric surgery to the roster of obesity procedures they cover.
Health insurers increasingly are choosing to cover a new type of bariatric surgery for obese patients. But that doesn’t mean employers will follow suit.
Sleeve gastrectomy is a newer form of obesity surgery. Instead of the conventional band that squeezes the size of the stomach, this procedure surgically shrinks the stomach. Surgeons say the procedure helps people lose up to half their excess weight in the first year or two after surgery.
Aetna and United Health recently announced they would reimburse for the procedure. John Meilahn, the head of Temple University’s bariatric surgery program, says the policy change is a great move — but it is not a guarantee for coverage.
Meilahn: People who have insurance through companies may have exclusions or riders which prohibit them from having bariatric surgery. That’s not something we saw too much of in the past. But I’m seeing more and more of that now. Another thing, though, that we’re seeing is that insurance companies are making it a bit harder for folks on average to have bariatric surgery. They require extensive testing and we see that they require a lot of documentation. and if things are not to their liking they will deny that procedure.
Still, all bariatric surgeries number in the hundreds of thousands annually, compared to only tens of thousands a decade ago.
Aetna says it changed the policy because studies showed that the sleeve works just as well or even better than the more common type of bariatric procedure, called gastric banding. Unlike conventional gastric banding, the sleeve is not adjustable, but there’s no foreign object implanted in the patient. Robert McDonough is the head of clinical policy, research and development at Aetna.
McDonough: I don’t know if it’s literally cost saving but it can improve health by reducing weight. You can also reduce the incidence of some of these diseases that are associated with morbid obesity and therefore improve clinical outcomes.
McDonough says he does not expect the policy change to affect premiums overall, because most plans already cover other types of bariatric surgery. The sleeve is simply an alternative.