Local News

New Medicare Guidelines May Create Influx Of Bariatric Surgery Cases

Posted February 27, 2006

— Medicare announced it will continue to pay for bariatric surgery for seniors. The decision could have a wide-ranging impact as private insurance companies may follow Medicare's lead.

Three years and 130 pounds ago, William Osborn weighed 390 pounds. The weight caused other health problems. Gastric bypass surgery helped him lose the weight and improve his health.

"Who knows -- I might have had a stroke, a heart attack or something," he said.

Medicare covered the operation because of his health problems. Now, the agency put out a new set of guidelines that could allow more recipients to get the surgery.

To qualify, patients must be significantly overweight, have failed other weight loss options and have at least one weight-related medical problem such as diabetes or sleep apnea.

Many private insurers have been hesitant to pay for the surgeries, but those same companies often follow Medicare's lead. Surgery advocates say paying for the procedure now would save insurers from obesity-related health care costs down the road.

"This doesn't mean that bariatric surgery is the perfect solution to a devastating problem, but it means it's the best solution that we have right now," said Dr. Mitchell Roslin, of Lenox Hill Hospital.

Before, Medicare only covered gastric bypass surgery where the lower part of the stomach is stapled off and detoured to the small intestine. Now, Medicare said it will also cover newer procedures where a band is used to squeeze down the size of the stomach.

Medicare coverage used to vary by region. The new rules are now uniform across the country.

Lack of insurance coverage has not stopped people from getting the surgery that can cost anywhere from $25,000 to $40,000. Even so, doctors performed about 170,000 bariatric surgeries in 2005.

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