Improved criteria for Regence members!

ALERT! REGENCE MEDICAL POLICY CHANGE

The Regence Group (which includes several Blue Cross Blue Shield affiliates in the states of Washington, Oregon, Idaho and Utah) has recently made 2 changes to their bariatric surgery medical policy no. 58 in the last couple of months.  Effective September 1, 2012, Regence (FINALLY!) included Sleeve Gastrectomy as one of its approved procedures.  Interestingly, it only approves the sleeve as a standalone surgery, but not as a “staged” procedure.

On the heels of that change, effective November 1st, Regence again revised its medical policy to eliminate one of the criteria elements in their pre-surgery diet criteria.  Regence required a patient lose weight or not gain weight during their “mandated” pre-surgical weight loss regimen.  It was a severe impediment for many patients.  That criteria was eliminated so if you are a patient (or treat a patient) who was denied by Regence because they did not lose weight during their pre-op diet you should IMMEDIATELY either (a) appeal that denial (if there is still time) or (b) resubmit a pre-authorization request to take advantage of this liberalization.

To review the updated Regence Group policy, click on this link:  Regence Group Bariatric Surgery Medical Policy

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