In the News ... Health Plan Policies and Guidelines

SRC's Division of Strategic Alliances works closely with payors to improve bariatric surgery benefits. If your program is experiencing issues regarding bariatric surgery coverage, please contact us. We want to hear your comments.

Blue Cross Blue Shield of Michigan Revises Bariatric Surgery Coverage Guidelines

Effective January 1, 2008, BCBS MI has revised the guidelines for payable gastric surgical procedures for morbid obesity. The major revisions include:

• Sleeve gastrectomy is now payable when provided as a first stage of a multi-staged bypass procedure for super obese (BMI >50 kg/m2), high-risk patients. It remains investigational and non-payable as a primary, single bariatric procedure.
• The 12-month timeframe for documented nonsurgical management prior to surgical intervention has been reduced to six (6) months.
• The required nonsurgical timeframe has been waived altogether for super obese, high-risk patients with a BMI greater than or equal to 50.

Aetna Revises Clinical Policy Bulletin for Obesity Surgery

Effective February 8, 2008, Aetna has revised the selection criteria of its Clinical Policy Bulletin for Obesity Surgery (number 0157) reducing the number of years a diagnosis of severe obesity exists. The CPB was revised to state that severe obesity must persist for two years prior to surgery approval ― a three-year reduction from the previous five-year requirement.

To view Aetna’s Clinical Policy Bulletin for Obesity Surgery click here.

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