Obesity has reached a crisis level in this country, with obesity registering at 30 percent of the population. Gastric bypass surgery is generally considered to be the best surgical procedure for the treatment of morbid obesity. In fact, doctors are expected to perform 140,000 bariatric surgeries in 2005 alone.
As payers and practitioners in the medical community, we are well aware of these statistics and their impact on overall healthcare costs. And, until recently, not all insurance plans considered bariatric surgery as a medically necessary procedure. This is about to change. Federal healthcare authorities have changed obesity to be classified as an illness. This change often results in gastric bypass surgery being classified as a medical necessity for many overweight adults that meet the following criteria:
The patient’s body mass index (BMI) is over 40
The patient has failed one or more non-surgical, medically supervised weight loss programs
The patient has received a thorough psychological exam that confirms he or she is able and willing to conform to the dietary adjustments required by the surgery
Other medical conditions may also have to be considered; however, this change means you, as a payer, may be expected to provide coverage for cases that, in the past, would not have been covered.
About AllMed Healthcare Management
Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base for its independent medical review and hospital peer review services includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. Read the AllMed Medical News Blog and the Independent Review Organization Blog.
