HMSA Refuses to Expand the Sleeve

After submitting a formal request for HMSA to review their Vertical Sleeve Gastrectomy Criteria, once again I receive a denial. Bascially, there is growing evidence that the Sleeve procedure provides good weight loss with acceptable safety. How much evidence does an insurance company need before it adjusts their criteria? Well, we have 6 year prospective data in the US, 10 year data internationally, major insurance carriers United Healthcare and Aetna now cover the sleeve, some Blue Cross insurance companies in the US cover the sleeve, our own program has over one year data on HMSA members who have undergone the sleeve and are doing well… and yet they still will not budge!

The good news is that momentum is in our favor to accept the Sleeve as a viable option for surgical weight loss with criteria similar to the Band and Bypass. But, we are going to have to be patient and wait for HMSA to catch up. I still have a hard time rationalizing why we must argue to get our surgeries covered when we know they save lives, improve quality of life, and decrease overall medical costs.