CMS Committee To Consider Medicare Coverage of Bariatric Surgery

As insurers across the nation consider increasing coverage of medical weight-loss treatments, a Medicare advisory committee on Thursday will examine data on bariatric weight-loss surgery to determine whether CMS should expand coverage of the surgery as a treatment for morbid obesity, the Wall Street Journal reports (Fuhrmans, Wall Street Journal, 11/3). In July, HHS Secretary Tommy Thompson announced that the department would remove language from Medicare's coverage manual that states obesity is not an illness. However, the program would not classify obesity as a disease, Thompson said. Currently, the program only covers obesity treatments when beneficiaries also have related conditions such as diabetes (California Healthline, 7/16).

According to the Journal, the Medicare committee could decide that there is enough evidence of the bariatric surgery's benefits to extend coverage to morbidly obese beneficiaries who do not yet have another disease. Such a decision could have repercussions across the health industry and lead to many more weight-loss surgeries, because private insurers often follow Medicare's lead, the Journal reports.

A number of insurers have begun to cover weight-loss surgeries and other medical treatments for obesity, according to the Journal. Managed care company First Health Group has created a specialized network of doctors with experience in bariatric surgery to reduce complication rates and costs related to the surgery.

In addition, Blue Cross & Blue Shield of North Carolina announced recently that it will cover weight-loss drugs Meridia and Xenical, and insurers such as Aetna and Cigna are offering weight-loss coaching programs for employer clients.

Such moves are a "huge medical-cost gamble" that some insurers have decided is not worth taking given lack of evidence of long-term benefit from bariatric surgery and other weight-loss treatments, the Journal reports.

Some health plans, including Blue Cross & Blue Shield of Florida, already have begun scaling back obesity treatment coverage because of cost and risk concerns. In addition, to offset cost concerns, Aetna beginning in January will require employer groups in its fully insured plans to purchase one of four special riders for coverage of bariatric surgery (Wall Street Journal, 11/3).