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Alabama insurer wants patients to wait for gastric bypass

Ambulatory Surgery Reimbursement Update, December 7, 2004

The debate about gastric bypass surgery and whether ASCs should be reimbursed for it continues to rage, with a major insurance provider in Alabama deciding, at least temporarily, not to pay for the surgery at all.

According to a story in the November 30 edition of the Huntsville Times, Blue Cross and Blue Shield of Alabama has ceased payment on gastric bypass surgery while the insurer contemplates instituting possible changes to their reimbursement policies. Blue Cross is proposing that patients must try a medically-supervised period of diet and exercise before opting for the surgery, as well as possibly seeking five years of physician weigh-ins for the patient before approving the procedure.

Jeff Brown of Huntsville Hospital thinks, however, that the new Blue Cross regulations may be too harsh for patients who legitimately need the surgery-which generally produces rapid and extreme weight loss following the surgical reduction of stomach size. "I think it's too onerous a burden placed on the patient," Brown told the Times. "They (these patients) aren't going to get healthier if we deny them this surgery."

Blue Cross and Blue Shield's decision may have been partially spurred on by the high numbers of patients seeking the procedure within the state. More than 700 patients in Huntsville alone underwent stomach reduction last year, and current figures show Alabama in competition with Mississippi and West Virginia atop the nation's obesity chart.

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