A191 Insurance Coverage Criteria for Bariatric Surgery

2019 ◽  
Vol 15 (10) ◽  
pp. S61-S62 ◽  
Author(s):  
Selim Gebran ◽  
Brooks Knighton ◽  
Ledibabari Ngaage ◽  
John Rose ◽  
Fan Liang ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Insurance Coverage ◽  
Coverage Criteria

Insurance Coverage Criteria for Bariatric Surgery: A Survey of Policies

2019 ◽  
Vol 30 (2) ◽  
pp. 707-713 ◽  
Author(s):  
Selim G. Gebran ◽  
Brooks Knighton ◽  
Ledibabari M. Ngaage ◽  
John A. Rose ◽  
Michael P. Grant ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Insurance Coverage ◽  
Coverage Criteria

Gender Surgery Beyond Chest and Genitals: Current Insurance Landscape

2019 ◽  
Vol 40 (4) ◽  
pp. NP202-NP210 ◽  
Author(s):  
Ledibabari M Ngaage ◽  
Katie L McGlone ◽  
Shan Xue ◽  
Brooks J Knighton ◽  
Caroline A Benzel ◽  
...  
Keyword(s):  
Insurance Coverage ◽  
Body Contouring ◽  
International Standards ◽  
Insurance Companies ◽  
Standards Of Care ◽  
Cross Sectional ◽  
Coverage Criteria ◽  
Telephone Interviews ◽  
Facial Surgery ◽  
Wide Variability

Abstract Background Plastic surgery plays an essential role in the treatment of gender dysphoria. International standards of care currently consider genital and chest surgeries to be medically necessary. Ancillary procedures such as facial surgery, chondrolaryngoplasty, hair restoration/removal, and body contouring are considered cosmetic surgeries except in individual circumstances. Objective The authors sought to assess the frequency of coverage provision for ancillary transition-related surgeries through a cross-sectional analysis of US insurance policies. Methods The authors selected insurance companies based on state enrollment data and market share. Policies were identified through web-based search and telephone interviews. A list of eligible procedures was compiled and grouped into 5 categories: body masculinization, body feminization, facial procedures, hair restoration/removal, and chondrolaryngoplasty. Medical necessity criteria from publicly accessible policies were then abstracted. Results Sixty-one insurance companies held an established policy. One-third of these policies offered favorable coverage for at least 1 ancillary procedure. Chondrolaryngoplasty was the most covered category (26%, n = 16), whereas body masculinization was the least covered (8%, n = 5). Almost two-thirds of the companies with favorable policies listed coverage criteria. We identified 4 recurring requirements: age, hormone therapy, continuous living in a congruent gender role, and referral from a mental health professional. Conclusions There is a low prevalence of US insurance coverage for ancillary gender surgeries and wide variability in coverage criteria. Reevaluation of ancillary transition-related procedures from cosmetic to medically necessary based on clinical judgement or establishment of defined coverage criteria may augment coverage and better address the needs of transgender patients.

scholarly journals Evaluation of Exome Sequencing Criteria for Hospital Stewardship and Insurance Authorization at a Pediatric Hospital

2021 ◽  
Author(s):  
Claire L. Wittowski ◽  
Sarah Clowes Candadai ◽  
Marie E. Perrone ◽  
Daniel F. Gallego ◽  
Jessie H. Conta ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Care Center ◽  
Insurance Coverage ◽  
Genetic Diseases ◽  
Tertiary Care ◽  
Pediatric Care ◽  
Molecular Diagnostic ◽  
Molecular Testing ◽  
Coverage Criteria ◽  
Significant Difference

Context.— Genomic molecular testing practices in a pediatric tertiary care institution. Objective.— To evaluate exome sequencing (ES) ordering practices and the effects of applying criteria to support ES stewardship. Exome sequencing can provide molecular diagnostic information for patients with known or suspected genetic diseases, but it is relatively expensive, and the cost is often borne by patients, institutions, and payers. Design.— We examined ordering patterns of ES approved by board-certified geneticists at our tertiary pediatric care center, as well as preauthorization outcomes for ES requests. We compared positivity rates among patients by patient phenotype, composite insurance coverage criteria, and insurance preauthorization outcome. Results.— Patients who met composite coverage criteria were more likely to receive a positive result from ES compared to patients who did not meet composite coverage criteria, though this trend was not statistically significant. There was no significant difference in ES results between patients who were denied or not denied preauthorization by insurance payers. Conclusions.— Insurance payers should consider implementing and/or expanding coverage criteria for ES and institutions should implement stewardship programs to support appropriate ES practices.

Value-based insurance coverage for bariatric surgery: time for surgeons to lead the change

2019 ◽  
Vol 15 (1) ◽  
pp. 152-154 ◽  
Author(s):  
Karan R. Chhabra ◽  
Justin B. Dimick ◽  
A. Mark Fendrick
Keyword(s):  
Bariatric Surgery ◽  
Insurance Coverage

scholarly journals Why Patients Seek Bariatric Surgery: Does Insurance Coverage Matter?

2014 ◽  
Vol 24 (6) ◽  
pp. 961-964 ◽  
Author(s):  
Phillip J. Brantley ◽  
Krystal Waldo ◽  
Molly R. Matthews-Ewald ◽  
Ricky Brock ◽  
Catherine M. Champagne ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Insurance Coverage

Reduced Survival in Bariatric Surgery Candidates Delayed or Denied by Lack of Insurance Approval

2016 ◽  
Vol 82 (2) ◽  
pp. 166-170 ◽  
Author(s):  
Eleisha Flanagan ◽  
Iman Ghaderi ◽  
D. Wayne Overby ◽  
Timothy M. Farrell
Keyword(s):  
Bariatric Surgery ◽  
Insurance Coverage ◽  
Surgical Care ◽  
Multidisciplinary Care ◽  
Rank Test ◽  
Kaplan Meier ◽  
Social Security Death Index ◽  
Multidisciplinary Care Team ◽  
Long Term Impact ◽  
Insurance Approval

Bariatric surgery reduces mortality for Americans who meet candidacy criteria and have insurance coverage. Unfortunately, some medically suitable candidates are denied or delayed during insurance approval processes. The long-term impact of such care delays on survival is unknown. Using a prospectively maintained bariatric intake database, we identified consecutive applicants who were evaluated and medically cleared by our multidisciplinary care team and for whom insurance approval was requested. We compared survival in those who were initially approved by their insurance carriers (controls) and those who were initially denied coverage (subjects). Mortality was determined using the Social Security Death Index. Kaplan–Meier survival curves were plotted and the log-rank test for significance was applied. From August 2003 to December 2008, 463 patients (391 females, mean age 45 ± 10 years, mean body mass index 52.5 ± 9.4 kg/m2) were medically cleared for a bariatric procedure. Of these, 363 were approved by insurance on initial request, whereas 100 were denied. Given the study's intention to measure the aggregate impact of delays and denials, nine patients who later came to operation after appeal or coverage change were maintained in the subject cohort. During 0- to 113-month follow-up, six subjects (6%) died compared with seven controls (1.9%), corresponding to a statistically significant survival benefit for patients initially approved for bariatric surgery without delay or denial ( P < 0.001). In conclusion, access to bariatric surgical care was impeded by insurance certification processes in 22 per cent of medically acceptable candidates. Processes that delay or restrict efficient access to bariatric surgery are associated with a 3-fold mortality increase.

scholarly journals Weight Loss Results and Compliance with Follow-up after Bariatric Surgery

2021 ◽  
Author(s):  
Beata M. M. Reiber ◽  
Anna-Marie R. Leemeyer ◽  
Marjolein J. M. Bremer ◽  
Maurits de Brauw ◽  
Sjoerd C. Bruin
Keyword(s):  
Risk Factors ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Cross Sectional Study ◽  
Median Percentage ◽  
Cross Sectional ◽  
Vitamin Deficiencies

Abstract Purpose The importance of follow-up (FU) for midterm weight loss (WL) after bariatric surgery is controversial. Compliance to this FU remains challenging. Several risk factors for loss to FU (LtFU) have been mentioned. The aim was therefore to evaluate the association between WL and LtFU 3 to 5 years postoperatively and to identify risk factors for LtFU. Materials and Methods A single-center cross-sectional study in the Netherlands. Between June and October 2018, patients scheduled for a 3-, 4-, or 5-year FU appointment were included into two groups: compliant (to their scheduled appointment and overall maximally 1 missed appointment) and non-compliant (missed the scheduled appointment and at least 1 overall). Baseline, surgical, and FU characteristics were collected and a questionnaire concerning socio-economic factors. Results In total, 217 patients in the compliant group and 181 in the non-compliant group were included with a median body mass index at baseline of 42.0 and 42.9 respectively. Eighty-eight percent underwent a laparoscopic Roux-en-Y gastric bypass. The median percentage total weight loss for the compliant and non-compliant groups was 30.7% versus 28.9% at 3, 29.3% versus 30.2% at 4, and 29.6% versus 29.9% at 5 years respectively, all p>0.05. Age, persistent comorbidities and vitamin deficiencies, a yearly salary <20,000 euro, no health insurance coverage, and not understanding the importance of FU were risk factors for LtFU. Conclusion Three to 5 years postoperatively, there is no association between LtFU and WL. The compliant group demonstrated more comorbidities and vitamin deficiencies. Younger age, not understanding the importance of FU, and financial challenges were risk factors for LtFU. Graphical abstract

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