Fallon Health Insurance: Sleeve Gastrectomy Coverage

The laparoscopic sleeve gastrectomy is a new weight loss procedure available to treat obesity and diabetes.  According to “Insurers Divided Over Experimental Stomach Surgery to Treat Obesity,” Matthew Sturdevant of The Hartford Courant says that some insurers are not covering the procedure while others are.  The procedure has the same goal as gastric bypass and gastric banding.  It shrinks the stomach to 15% of the original size so that you eat less.  Fallon health insurance and other insurers have had to make a tough decision whether or not to cover the newer procedure.  Some companies believe that more research should be done, while others are already covering the costs to help avoid the other long term costs related to obesity and diabetes.

UnitedHealthCare and Aetna decided to cover the sleeve gastrectomy at a cost of $16,000-$25,000 for the procedure.  CIGNA Corp. and Anthem Blue Cross Blue Shield of Connecticut are not covering the procedure currently because they believe it is experimental and needs more research to be proven effective and safe.  The sleeve gastrectomy procedure turns the shape of the stomach into a sleeve rather than the natural kidney bean shape.  It is deemed better than gastric bypass by some people because it doesn’t skip over the small intestine where important nutrients are absorbed.  The benefit over gastric banding is that you don’t have to have repeat surgeries like you do to adjust the gastric band.  Some advocates believe that the sleeve gastrectomy pays for itself in about two years because of the obesity related health costs that are avoided.

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