BCBS NE thoughts anyone??

The following surgical procedures are scientifically valid in the treatment of morbid obesity:

* Roux en Y Gastric bypass

* Gastric stapling

* Biliopancreatic diversion with duodenal switch

* Laparoscopic or open gastric banding (e.g., Lap-Band)

* Loop gastric bypass

Laparoscopic methods to perform the above procedures are scientifically validated.

All other surgical procedures, including biliopancreatic diversion without duodenal switch, are investigative.

POLICY GUIDELINES:

The screening criteria listed below should be utilized before any surgery would be considered medically necessary:

MEDICAL POLICY MANUAL

1. The patient must have morbid obesity (BMI of >/= 40 kg/meter squared) or a BMI of 35- 40 kg/meter squared plus significant comorbidity.

2. The duration of obesity must have exceeded five years.

3. No identified treatable medical cause (i.e., endocrinologic).

4. Age >/= to 16 years of age.