vsg , sleeve in Mass with Blue Cross
VSG on 04/23/12
FWIW...I had my 2nd appt with the surgeon today and they're putting in my paperwork for the sleeve. BCBS of MA covers the sleeve as of January 1, 2012. This is straight from their Medical Policy #379 originally dated 5/96 and updated 1/1/12:
"Surgical Management:
The following bariatric surgeries may be considered medically necessary (covered) for obesity that has not
responded to conservative measures in patients who meet the "Patient Selection Criteria" described in this
policy:
Gastric Restrictive Procedures
* Vertical-banded gastroplasty (gastric stapling)
* Open gastric bypass using Roux-en-Y anastomosis with an alimentary or "Roux" limb of 150 cm or
less
* Laparoscopic gastric bypass using a Roux-en-Y anastomosis
NOTE: Blue Cross Blue Shield of Massachusetts expects hospitals to abide by the Betsy Lehman
Report. The report notes that Laparoscopic Roux-en-Y should only be performed by "appropriately
trained, qualified, laparoscopic weight loss surgeons."
* Adjustable Gastric banding consisting of an external band placed around the stomach
NOTE: The Adjustable Gastric banding systems are not proven to be safe in non-adult patients
(patients under 18 years of age).
* Sleeve gastrectomy"
I am so flippin' excited about this!!!
"Surgical Management:
The following bariatric surgeries may be considered medically necessary (covered) for obesity that has not
responded to conservative measures in patients who meet the "Patient Selection Criteria" described in this
policy:
Gastric Restrictive Procedures
* Vertical-banded gastroplasty (gastric stapling)
* Open gastric bypass using Roux-en-Y anastomosis with an alimentary or "Roux" limb of 150 cm or
less
* Laparoscopic gastric bypass using a Roux-en-Y anastomosis
NOTE: Blue Cross Blue Shield of Massachusetts expects hospitals to abide by the Betsy Lehman
Report. The report notes that Laparoscopic Roux-en-Y should only be performed by "appropriately
trained, qualified, laparoscopic weight loss surgeons."
* Adjustable Gastric banding consisting of an external band placed around the stomach
NOTE: The Adjustable Gastric banding systems are not proven to be safe in non-adult patients
(patients under 18 years of age).
* Sleeve gastrectomy"
I am so flippin' excited about this!!!