Tufts tightens bariatric requirements
NEWS IN BRIEF — Posted March 5, 2007
As of March 6, it will be much more difficult for members of Tufts Health Plan in Massachusetts to get bariatric surgery or stomach banding procedures. The plan said it would require prospective weight-loss surgery patients to go through a Tufts-sponsored yearlong diet and counseling program before it would consider paying for a procedure.
After completing the program, patients with a body mass index of less than 40 would not be eligible for a procedure. Those with a BMI between 40 and 50 would be eligible for stomach banding. Exceptions would be made if patients with a BMI between 40 and 50 had medical conditions such as hypertension or diabetes. A BMI of 40 is considered severely obese.
Doctors have protested Tufts' move, saying it ignores medical evidence that bariatric surgery can help patients, particularly those with comorbidities, who have exhausted other ways of trying to lose weight. They also said Tufts' move could worsen conditions for some obese patients by delaying surgery.
Other insurers nationwide have cut or restricted use of bariatric procedures, although Tufts' plan is more restrictive than other major Massachusetts insurers. The American Society for Bariatric Surgery says 177,600 weight-related surgeries were performed in the U.S. last year, up from 36,700 in 2000.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/03/05/bibf0305.htm.