888-765-5400BCBSNC to Cover Sleeve Gastrectomies Procedure
Beginning July 1, 2011, BCBSNC will cover the sleeve gastrectomy procedure for qualified members who meet the criteria outlined in our medical policy titled “Surgery for Morbid Obesity.” You can search the medical policy on 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 our medical policy, the 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.
The information from this article was posted by BCBSNC titled “BCBSNC to Cover sleeve Gastrectomies Procedure was Previously Considered Investigational” Date: 07/01/2011.
For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.
