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:
(a) Have a body mass index (BMI) of forty (40) or over and have been diagnosed as being morbidly obese;
(b) Have a body mass index (BMI) between thirty-five (35) and forty (40) and has a serious weight-related health problem;
(c) Can provide documented evidence of other methods of weight loss which have been tried over the past twenty-four (24) months, and
(d) Have been through a psychological assessment which has confirmed that it is appropriate for the insured to undergo the procedure. The bariatric surgery technique needs to be evaluated by the insurer’s medical teams and is subject to the insurer’s medical policy criteria. The insured must contact the insurer for pre-authorization before proceeding with treatment. Benefit may not be paid unless pre-authorization has been provided.
Bariatric Surgery. This benefit has one or more exclusions as specified in the Exclusions section. 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). Exclusion This benefit has one or more exclusions as specified in the Exclusions section
Bariatric Surgery. (Please refer to the Benefit Schedule for other benefit provisions which may apply.)
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 Basic program. The primary medical benefits authorized under chapter 55 of title 10 U.S. Code, and set forth in
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. 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 by Presbyterian Health Plan, and designated as an accredited bariatric surgery Center by the American Society of Metabolic and Bariatric Surgery/American College of Surgeons. Biomarker testing is for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of a member’s disease or condition is covered if the test is supported by medical and scientific evidence such as FDA approval, CMS national or local coverage determinations, or nationally recognized clinical practice guidelines. Biomarker testing may be subject to cost sharing consistent with that imposed on testing benefits.
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. Surgical procedures performed to treat co-morbid condi- tions associated with morbid obesity. 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.
