Earlier this year, Massachusetts-based Tufts Health Plan took a tough stance on bariatric surgery, imposing strict new limits on which patients it considered appropriate for the surgery. The health plan planned to limit reimbursement for bariatric surgeries to patients with a BMI of 40 or more, and were restricting many patients to laparascopic banding procedures rather than more-expensive gastric bypass surgery. Tufts had also planned to make patients spend 12 months in a lifestyle counseling program before getting the surgery. But after taking a beating from health officials and physicians--who argued that Tufts was ignoring clinical evidence that such procedures work for many morbidly obese patients--executives have backed off from their original plans.
Tufts has now retooled its bariatric surgery policy, following guidelines established by bariatric surgeons associated with Tufts-New England Medical Center. For one thing, the health plan has cut the minimum BMI for such surgeries to above 35 if patients face complications like diabetes or hypertension. The company has also agreed to pay for both gastric banding or gastric bypass procedures, and has cut the minimum period patients must spend in lifestyle counseling from 12 months to six months.
To learn more about the dispute:
- read this article from The Boston Globe
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