Bariatric Surgery an operation on the stomach and/or intestines intended to help promote weight loss including, but not limited to, vertical banded gastroplasty, gastric stapling, laparoscopic adjustable gastric banding, mini-gastric bypass, gastric bypass with Roux-en-Y, biliopancreatic diversion, biliopancreatic diversion with duodenal switch, long- limb gastric bypass, intestinal gastric bypass, or any other surgical procedure designed to restrict an individual’s ability to assimilate food.
Bariatric Surgery. The procedure will be covered after a waiting period of twenty-four (24) months and meeting the following criteria:
Bariatric Surgery. This benefit has one or more exclusions as specified in the Exclusions section. Surg cal treatment of morbid obesity (bariatric surgery) is Covered only if it is Medically Necessary as defined in this Agreement. Bariatric surgery is Covered for patients with a Body Mass Index (BMI) of 35 kg/m2 or greater who are at high risk for increased morbidity due to specific obesity related co- morbid medical conditions; and I a Covered Benefit only if a Member meets this criteria and all other requirements of t is Agreement. Prior Auth Required Prior Authorization is required and services must be performed at an In-network facility that is designated by Presbyterian Health Plan, and designated as a bariatric surgery Center of Excellence by Centers for Medicare and Medicaid Services (CMS). Cancer Clinical Trials Exclusion This benefit has one or more exclusions as specified in the Exclusions section Routine patient care costs that are incurred as a result of participation in a Cancer Clinical Trial in New Mexico are Covered. Routine patient care costs mean: o Medical service or treatment that is a benefit under this Health Benefits Plan would be Covered if the patient were receiving standard cancer treatment or that
Bariatric Surgery. (Please refer to the Benefit Schedule for other benefit provisions which may apply.) This Plan provides benefits for Covered Charges made for medical and surgical services: • for the treatment or control of clinically severe (morbid) obesity as indicated below, and • if the services are demonstrated, through existing peer reviewed, evidence based, scientific literature and scientifically based guidelines, to be safe and effective for the treatment or control of the condition. Obesity screening and counseling for adults is recommended by the United States Preventive Services Task Force (USPSTF) as a Body Mass Index (BMI) of 30kg/m or higher to intensive, multicomponent behavioral interventions. For children age 6 years and older the USPSTF recommends that clinicians screen for obesity and offer or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status. The following items are specifically excluded: • medical and surgical services to alter appearances or physical changes that are the result of any medical or surgical services performed for the treatment or control of obesity or clinically severe (morbid) obesity; and • weight loss programs or treatments, whether or not they are prescribed or recommended by a Physician or under medical supervision.
Bariatric Surgery. Surgical procedures performed to treat co-morbid condi- tions associated with morbid obesity. Bariatric surgery is based on two prin- ciples: (1) Divert food from the stomach to a lower part of the digestive tract where the normal mixing of digestive fluids and absorption of nutrients can- not occur (i.e., Malabsorptive surgical procedures); or (2) Restrict the size of the stomach and decrease intake (i.e., Restrictive surgical procedures). Basic program. The primary medical benefits authorized under chapter 55 of title 10 U.S. Code, and set forth in § 199.4 of this part.
Bariatric Surgery. Surgical procedures to treat obesity have been performed since the 1950s265 and include truncal vagotomy266, jaw wiring267, intragastric balloons and liposuction. Bariatric (weight loss) surgery can be divided into purely restrictive procedures (vertical banded gastroplasty [VBG], laparoscopic adjustable silicone gastric banding [LASBG]) and combined restrictive and malabsorptive procedures (Roux-en-Y gastric bypass [GBP], biliopancreatic diversion [BPD])57,268. The latter induce larger weight losses and, hence, greater improvements in hy- pertension, dyslipidaemia, glucose metabolism and hyperinsulinaemia as compared to the purely restrictive techniques50,56. However, they are irreversible, sometimes leading to greater weight losses than necessary and also to nutritional deficiencies. Patients have to take vitamin supplements for the rest of their lives. LASBG is the most popular form of bariatric surgery in the Netherlands (and the rest of Europe), because it can be performed laparoscopic and therefore has fewer perioperative complications and it is reversible. In addition, some influ- ence as to the amount of food intake can be exerted via inflation/deflation of the saline-filled gastric ring57,268. This procedure also has disadvantages however, an estimated 7-17% of the patients has to be re-operated because of band erosion, dislocation or leakage or because of esophageal dilatation269,270. Bariatric surgery can induce large weight losses (20-50% of body weight) with a higher likelihood of maintaining weight loss (especially the combined restrictive and malabsorptive procedures) as compared to other weight loss interventions55,271. The Swedish Obese Subjects (SOS) study showed that surgically-treated obese subjects had about 25% percent greater weight loss at 10 years follow-up, along with a greater number of persons who no longer had diabetes (if present), hypertriglyceridaemia, low HDL-cholesterol concentrations, hypertension and hyperurikaemia as compared with conventionally treated obese subjects. The surgery group also had lower 2- and 10-year incidence rates of diabetes and hypertriglyceridaemia, but not hypercholesterolaemia43. Others have reported similar beneficial metabolic effects of bariatric surgery. Bariatric surgery has also been performed in patients with type 2 diabetes. Although in some studies the number of patients with diabetes were small52,55, the impressive results found were confirmed in larger studies51,53. A recent meta-analys...
Bariatric Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Surgical treatment of morbid obesity (bariatric surgery) is Covered only if it is Medically Necessary as defined in this Agreement. Bariatric surgery is Covered for patients with a Body Mass Index (BMI) of 35 kg/m2 or greater who are at high risk for increased morbidity due to specific obesity related co- morbid medical conditions; and Prior Authorization is required and services must be performed at an In-network facility that is designated as an accredited bariatric surgery Center by the American Society of Metabolic and Bariatric Surgery/American College of Surgeons.
Bariatric Surgery. Surgical procedures performed to treat co-morbid condi- tions associated with morbid obesity. Bariatric surgery is based on two prin- ciples: (1) Divert food from the stomach to a lower part of the digestive tract where the normal mixing of digestive fluids and absorption of nutrients can- not occur (i.e., Malabsorptive surgical procedures); or (2) Restrict the size of the stomach and decrease intake (i.e., Restrictive surgical procedures). Basic program. The primary medical benefits set forth in § 199.4, generally referred to as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) as authorized under chapter 55 of title 10 United States Code, were made available to el- igible beneficiaries under this part.
Bariatric Surgery. Open or laparo- scopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic sleeve gastrectomy (SG), open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable sili- cone gastric banding (LASGB) are covered when specific health criteria are met;
Bariatric Surgery. This benefit has one or more exclusions as specified in the Exclusions section. Surgical trea ment of morbid obesity (bariatric surgery) is Covered only if it is Medically Necessary as defined in this Agreement. Bariatric surgery is Covered for atients with a Body Mass Index (BMI) of 35 kg/m2 or greater who are at high risk for increased morbidity due to specific obesity related co- morbid medical conditions; and Prior Auth Required Prior Authorization is required and services must be performed at an In-network facility t at is designated by Presbyterian Health Plan, and designated as a bariatric surgery Center of Excellence by Centers for Medicare and Medicaid Services (CMS). Cancer Clinical Trials Exclusion This benefit has one or more exclusions as specified in the Exclusions section Routine patient care costs that are incurred as a result of participation in a Cancer Clinical Trial in New Mexico are Covered. Routine patient care costs mean: o Medical service or treatment that is a benefit under this Health Benefits Plan that would be Covered if the patient were receiving standard cancer treatment or o A drug provided to a patient during a Cancer Clinical Trial if the drug has been approved by the United States Food and Drug Administration (FDA), whether or not that organization has approved the drug for use in treating the patient’s particular condition, but only to the extent that the drug is not paid for manufacturer, distributor or provider of the drug. Routine patient care costs are Covered for Members in a Cancer Clinical Trial if: by the o The Cancer Clinical Trial is undertaken for the purposes of the prevention of or the prevention of reoccurrence, early detection, or treatment of cancer for which no equally or more effective standard cancer treatment exists. o The Cancer Clinical Trial is not designed exclusively to test toxicity or disease pathophysiology and it has a therapeutic intent. o The Cancer Clinical Trial is being provided in New Mexico as part of a scientific study of a new therapy or intervention. o There is no non-Investigational treatment equivalent to the Cancer Clinical Trial. o There is a reasonable expectation shown in clinical or pre-clinical data that the Cancer Clinical Trial will be at least as efficacious as any non-Investigational alternative. o There is a reasonable expectation based on clinical data that the medical treatment provided in the Cancer Clinical Trial will be at least as effective as any other med...
