An insurer doing something GOOD for bariatric patients?!?

BIG NEWS! Several insurers are going to REMOVE pre-surgery supervised diet requirements

YOU MUST READ THIS if your health coverage comes from Blue Cross Blue Shield of Illinois, Texas, Montana, New Mexico or Oklahoma in 2019!

(And probably should read it even if you’re not!)

Why?  Those 5 companies are part of HEALTH CARE SERVICE CORPORATION (HCSC) and they are making a major change which affects anyone insured by them in 2019 who is considering having bariatric surgery.  The HCSC Bariatric Surgery Medical Policy no. SURG716.003 is going to become effective February 1, 2019 and, believe it or not, they are eliminating any formal requirement that patients engage in supervised weight loss for a particular time frame (e.g. 3, 6, 12 months, etc.) prior to surgery.

Patients, surgeons and integrated health professionals are impacted by this and it is obviously an extremely unusual, pro-patient, action.  Here is the Rationale which they published explaining why they are FINALLY eliminating this ridiculous hoop that has caused so many patients so much needless delay in getting medically necessary treatment:

Patient Selection Criteria for Coverage

“A requirement that a candidate for bariatric surgery complete a formal, medically supervised weight loss programs of specified duration has been a fixture of Health Care Service Corporation (HCSC) bariatric surgery medical policy for some time. The rationale for this requirement was founded on review and interpretation of available evidence in the scientific medical literature, primarily national consensus guidelines. However, HCSC has decided to modify this requirement based on a current review of the bariatric surgery scientific literature related to required pre-surgery weight loss programs, and including consideration of input from bariatric surgeons and their professional societies. The HCSC policy will no longer require documentation that a morbidly obese member must have completed a pre-surgery weight loss program of specified duration as one of the criteria for benefit coverage of bariatric surgery. This change does not mean, however, that HCSC no longer believes that successful bariatric surgery requires multi-disciplinary support from the member’s bariatric surgery program and a life-long commitment to life-style changes.”  

REMEMBER this new medical policy does not take effect until February 2019!  So while this is great news I don’t want anyone jumping the gun and deciding he or she can just ditch their current diet.  It pains me to say that because we do not believe in them and there is no evidence to support having a requirement which delays care for folks like us who are in desperate need.  But until this medical policy becomes effective the most prudent course of action is to continue on, especially if you are close to the end.  Other things you may wish to consider doing is:

  • Immediately let your bariatric program’s insurance coordinator know about this upcoming change.  They may have provider relations representatives who can give them more information about how to proceed.

  • If anyone is getting push-back from their bariatric program (“You’re wrong…..”  “I don’t believe it……”), tell them to call our office (1-877-992-7732) and we will be happy to share what we know. Of course anyone needing guidance about bariatric surgery insurance concerns are encouraged to call us as well.  We can help!

  • Please share this post with anyone who you think might benefit from the HCSC change – – we are a COMMUNITY and need to watch each other’s backs!

  • If you are NOT insured by one of these companies you may want to consider educating YOUR insurance company about this change and advocate for your insurer to do the same.  If advocacy is too intimidating I can heartily recommend contacting the amazing Obesity Action Coalition  because they may be able to help point you in the right direction.

REMEMBER this change ONLY IMPACTS people insured by the five Blue Cross Blue Shield companies I listed – it is not a change that affects EVERYONE insured by one of the “Blues” or Aetna or CIGNA or United Healthcare or…..[fill in the blank since the list goes on and on and on].  Most insurers continue to enforce these dietary requirements and they are DANGEROUS! 

Read this if you want evidence as to how dangerous they are: 

“In conclusion, access to bariatric surgical care was impeded by insurance certification processes in 22 per cent of medically acceptable candidates. Processes that delay or restrict efficient access to bariatric surgery are associated with a 3-fold mortality increase.”

Anything that starts with the words “REDUCED SURVIVAL” ought to terrify us all and must be stopped.  Thus, we continue to urge bariatric programs across the nation to not allow insurance companies in their region dictate how to practice medicine – which is exactly what is happening.  Instead we beg providers across the nation to not just force a person to go through a dangerous dietary program just because “your insurance company requires it.”  Take a stand and fight these denials whenever possible.

 

We stand ready to help anyone who needs to appeal these denials.  Only after fighting and winning these battles are we going to have the opportunity to announce similar patient-friendly changes to other insurer medical policies.

 

 

601-C East Palomar Street #480 Chula Vista, California 91911 Tel - 877-992-7732 Fax - 844-384-9199

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