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Aetna and UnitedHealthcare Wants Lean Members – Bariatric Surgery To be Covered for Morbidly Obese Patients

Posted Apr 20 2010 12:58pm

We know analytics lead to this conclusion and the need to lose weight, which is a focus all over the US anyway, but with those patients needing this type of surgery image it looks like there’s hope on the horizon as it is cheaper and more efficient to maintain a slimmer body than a heavy one. 

I’m sure when more details come out, you will need to be “in network” here to be eligible.  Good news is that it jumps out from that “investigational” category that stops many procedures from taking place and/or being approved. It’s getting expensive to be obese too with ambulances adding on premium charges and let’s face it, you don’t wan to be admitted to a hospital on a forklift, and I don’t mean driving it but rather as cargo.  In some areas if an individual is too big, they won’t fit in the MRI too, so this is a good thing both ways it appears but the algorithms to show cost effectiveness were there, you can bank on that.  BD 

Health insurance giants, Aetna Inc. and United Healthcare, announced their plans to insure laparoscopic sleeve gastrectomy, a new form of bariatric surgery for morbidly obese patients. The new policy changes are in response to positive results of the most recent method to treat morbid obesity.

Obesity-related complications, such as type 2 diabetes, are costly for health insurers, making their commitment to cover obesity surgeries unexplainable. Metabolic surgeries however, are ever-changing making investigational research important before they can be covered, which is the reason laparoscopic sleeve gastrectomy wasn't covered until recently.

The American Society for Metabolic and Bariatric Surgery stated that “sleeve gastrectomy” (SG) is now a risk-reduction initial treatment strategy for at-risk patients. Roux-en-Y Gastric Bypass, Laparoscopic Adjustable Gastric Banding and Biliopancreatic Diversion with Duodenal Switch are also on the list of common metabolic surgeries.

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