New York Insurers Release Weight Control Surgery Guidelines
New York state health insurers have worked with top surgeons to develop guidelines for evaluating requests for weight control surgery coverage.
Members of a review team organized by the New York Health Plan Association, Albany, N.Y., say covering the surgery sometimes makes sense.
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Although bariatric surgery, or moves to reduce a patients stomach capacity, can cause serious complications, it “can improve most obesity-related conditions, reduce the risk of premature death and improve quality of life for patients who are morbidly obese,” says Dr. Susan Beane, a review team member who is medical director of Affinity Health Plan, New York.
Plans should consider covering bariatric surgery for a candidate aged 18 to 65 who has a body mass index over 40 or for a patient with a BMI over 35 and obesity-related health problems, according to the NYHPA guidelines.
For a man of average height, a BMI over 40 means that the man is about 100 pounds over the average weight.
Candidates also should stop smoking, overcome any other substance abuse problems and show that they have failed at efforts to diet, and plans should encourage candidates to use high-volume bariatric surgery centers, the NYHPA review team says.