Aloha Surgery Blog

Weight Loss Surgery Resources, News, Tips and more

Medicare Revises Their Coverage for the Sleeve

The Centers for Medicare and Medicaid Services (CMS) have confirmed the removal of the Non-Covered status indicator for Sleeve Gastrectomy beginning October 1, 2012.

Recent events have been favorable for the continued wide-spread acceptance of the Vertical Sleeve Gastrectomy. CMS, which governs Medicare policy, initially decided against covering the sleeve outside of research protocols back in October of 2011. Through much lobbying by the American Society for Metabolic and Bariatric Surgery, CMS reconsidered its decision and submitted a reversal in June of this year.

Another step in the right direction occurred at the end of August, when the decision was made to officially remove the “Non-Covered” status for the Sleeve. This is a clear message to the regional carriers to start covering the Sleeve Gastrectomy starting this Fall. It’s about time Medicare beneficiaries are given access to this life-changing procedure!

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HMSA Covers the Sleeve

Some of you guys already know this great news… HMSA now covers the Sleeve with the same criteria as for the Gastric Bypass and Band. Basically, a Vertical Sleeve Gastrectomy can be considered for individuals with a BMI greater than 40, or a BMI greater than 35 with some significant health condition.

This has been a long time coming. I remember three years of meetings with the HMSA directors, advising them of the need to cover this procedure with the standard bariatric criteria. It’s about time for the Sleeve to be considered a viable option for surgical weight loss!

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