Aetna Covers Gastric Sleeve

Insurance Company to Cover Newer Method of Bariatric Surgery

Aetna Insurance for Obesity SurgeryAetna, one of the nations largest health insurers, revised its policy on obesity surgery this month to include open and laparoscopic sleeve gastrectomy among its covered bariatric procedures.

The sleeve gastrectomy procedure, often referred to as the gastric sleeve, is a newer method of bariatric surgery that is gaining in popularity as a treatment for morbid obesity.

The gastric sleeve promotes weight loss by reducing the size of the stomach to help patients eat less and feel full faster. It appeals to many patients as it does not require a medical implant or need adjustments like laparoscopic adjustable gastric banding and does not require cutting and rerouting the small intestine like the gastric bypass procedures.

Prior to the policy change, Aetna considered the sleeve gastrectomy ‘investigational’ and did not cover the surgery. As of 4/9/2010, Aetna revised its Clinical Policy Bulletin for Obesity Surgery and stated that the “sleeve gastrectomy is considered medically necessary when criteria are met.”

The policy now reads: Aetna considers open or laparoscopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic sleeve gastrectomy, open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB) medically necessary when the selection criteria listed below are met.

Although the sleeve gastrectomy is included under bariatric procedures, coverage for obesity surgery is still dependent on benefit plan details and approval by Aetna.

Aetna’s decision follows in the footsteps of United Healthcare, another healthcare giant, which began covering the procedure in October 2009.

In response to the Aetna and United Healthcare change in policy, The American Society for Metabolic and Bariatric Surgery (ASMBS) issued a press release announcing its support. In the statement, John W. Baker, MD, FACS, President of ASMBS, said “We are pleased that Aetna and United Healthcare now includes sleeve gastrectomy among its covered bariatric procedures…Sleeve gastrectomy has now reached that threshold where the data and our experience with the procedure supports its safe and effective use in people affected by the chronic disease of morbid obesity.”

The ASMBS, which is the largest organization for bariatric surgeons in the world, is a non-profit group committed to educating medical professionals, patients, and the general public to the various effects, risks, and benefits of bariatric surgery.

The decision of Aetna and United Healthcare to cover gastric sleeve will benefits patients who are morbidly obese and considering weight loss surgery. While weight loss surgery is the most effective treatment for morbid obesity, it should not be considered a “one size fits all” approach. As the best surgical intervention for obesity can vary from patient to patient, insurers who cover a wider range of options will better allow surgeons to treat patients on a more personal basis.

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