United Healthcare Covers Gastric Sleeve

Nov 22, 2009

United Healthcare (UHC), one of the largest health carriers in the United States, has changed its bariatric medical policy to include coverage for gastric sleeve surgery. The new policy, which went into effect October 1, 2009, is a significant event for bariatric surgery patients and gastric sleeve advocates.

UHC’s decision reflects a fundamental change in their position on the effectiveness of the gastric sleeve procedure. They no longer refer to the gastric sleeve as an “experimental” procedure in their health plans, but as a “proven” treatment for clinically severe obesity. This recognition makes United Healthcare the first major insurer to cover the gastric sleeve as a complete bariatric surgical option.

Not only does this new policy have the potential to affect the more than 20 million individuals covered by United Healthcare, but their decision could influence other insurers to cover the gastric sleeve as well.

The language from the UHC Bariatric Medical Policy that was in effect before the change stated: The gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch is unproven due to inadequate clinical evidence of safety and/or efficacy in published, peer-reviewed medical literature.

The language from the new UHC Bariatric Medical Policy now states: The gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch (BPDDS or DS) is proven in adults for the treatment of clinically severe obesity as defined by the National Heart Lung and Blood Institute (NHLBI).

UHC’s coverage for the gastric sleeve will be the same as for the other bariatric procedures that they cover. Actual coverage will still vary between specific health plans, as some employers do not offer policies with coverage for bariatric surgery.

Traditionally, the gastric sleeve was only performed as the first stage of the duodenal switch surgery. After several years of study, however, it is now gaining the attention and acceptance of many top bariatric surgeons as a standalone surgical weight loss option since it generally leads to significant weight loss with few complications.

Some bariatric surgeons are even suggesting that the gastric sleeve has the potential to surpass the popularity of gastric bypass surgery and laparoscopic adjustable gastric banding. The current data indicates that the gastric sleeve results in quicker weight loss than gastric banding with fewer complications than gastric bypass surgery. Only time will tell whether the long term results are as impressive as the short term results.

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