SeniorJournal.com, 18th November 2008

Medicare Is not going to pay for the weight-loss surgery of patients with diabetes whose BMI is lower than 35.

Centers for Medicare & Medicaid Services (CMS) suggested the coverage policy for batriatic surgery for patients with type 2 diabetes was BMI 35. The other suggestion was not to cover the surgery if its purpose is to treat type 2 diabetes with a BMI below 35.

Kerry Weems from CMS finds weight-loss operation is a life-saving option for the patients who have unsuccessfully tried to lose weight in other ways. “CMS wants to be sure that these patients have access to a solution to help them achieve a healthier weight and avoid some of the most serious complications of type 2 diabetes,” he adds.
The coverage of batriatic surgery was expanded in 2006 for Medicare patients who underwent the surgery from highly qualified surgeons. In order to get the coverage, patients’ BMI needs to be at least 35 and, next to severe obesity, have serious health issues such as coronary artery disease, osteoarthritis or hypertension.

CMS covers four types of weight-loss operations: gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch.

A new suggestion is not to cover surgery for those patients whose BMI is lower than 35 even if they have got diabetes. CMS is convinced it is the right decision even if batriatic surgery is very helpful for these patients.

Comments from the public confirming efficiency of the weight-loss procedure with diabetes are being searched for.

“Limiting coverage of bariatric surgery in type 2 diabetic patients whose BMI is less than 35 is part of Medicare’s ongoing commitment to ensure access to the most effective treatment alternatives with good evidence of benefit, while limiting coverage where the current evidence suggests the risks outweigh the benefits,” said Barry Straube, the CMS MD.

The public are welcome to respond to the decision on: http://www.cms.hhs.gov/center/coverage.asp.

This entry was posted on Friday, November 21st, 2008 at 10:36 am and is filed under Weight Loss. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.