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Access to surgery

ASMBS: Collaboration is a victory for patients

Insurer changes policy eliminates participation in a non-surgical weight reduction programme before surgery

The ASMBS has reported that collaboration between the ASMBS Carolinas State Chapter and insurer, Blue Cross and Blue Shield of North Carolina (BCBSNC), has resulted in a  revised coverage policy that eliminates the six-month requirement for patients to participate in a non-surgical weight reduction programme prior to being considered for bariatric surgery.

“The real victory is for patients,” said Dr Ranjan Sudan, president of the ASMBS Carolinas State Chapter. “We laid out our concerns, backed it up with evidence and worked with BCBSNC in a highly constructive way that led to a change in policy. They were very receptive to what we had to offer and we were very responsive to their questions.”

Dr Ranjan Sudan

According to the report, the BCBSNC added the requirement in September 2013, to previously existing restrictions on revision surgery and duodenal switch, despite the ASMBS stating that there lack of evidence demonstrating any benefit. BCBSNC had added this requirement in Sept 2013, to previously existing restrictions on revision surgery and duodenal switch.

“We were very pleased with the process,” said Dr Janet L McCauley, Senior Medical Director, Medical and Reimbursement Policy, BCBSNC. “We received input, evidence-based data and feedback related to our policy in a consistent and consolidated fashion. We went from individual conversations with surgeons with varying points of view to unified discussions with the bariatric community. There was a collective voice.”

In addition to removing pre-surgery requirement, the insurer has also revised its policy and duodenal switch patient criteria in line with ASMBS guidelines and recommendations. Previously revisions were allowed only for complications from bariatric surgery and duodenal switch was reserved for patients with a BMI>50.

“Overall the language and references have been updated to reflect current evidence-based practices,” said Sudan. “This has been a model process that has removed barriers and improved access to care for our patients. We remain committed to continuing a constructive dialog and building on the professional and trusting relationship we have established through the chapter.”

The ASMBS remains hopeful that insurers throughout the US will follow the example of BCBSNC.

“The data is there to support greater use of metabolic and bariatric surgery for obesity and related diseases, including diabetes, and we must continue to find common ground with insurers to improve access,” said Dr John Morton, president-elect of the ASMBS. “This experience in North Carolina shows us we can do that when we are organised, persistent and collaborative. Everybody wins.”

To access the article on the ASMBS website, please click here

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American Society for Metabolic and Bariatric Surgery

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