Aetna Changes It's Policy and Now Covers the Gastric Sleeve Operation!

Today I was informed of the following:


As of April 9, 2010, Aetna has changed its position on reimbursement for sleeve gastrectomy, and will now cover the procedure. This coverage will be the same as the other bariatric surgery procedures covered by Aetna.

Per the official Aetna coverage policy, “Aetna considers open or laparoscopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic sleeve gastrectomy, open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB) medically necessary when the selection criteria are met.” (Selection Criteria detailed in the policy -0157).

This policy has the potential to impact over 18 million lives covered by Aetna.


This means Aetna now joins several other medical insurance companies in the Ohio area including Medical Mutual, United Health Care and Humana,(through OhioHealth),that cover the gastric sleeve procedure.

This is great news since the gastric sleeve procedure is increasingly the operation preferred by many people that come to Fresh Start Bariatrics at Riverside to have their bariatric operation.

I have performed over 100 gastric sleeve operations over the last two and a half years and have found that this operation is comparable to a gastric bypass operation in the amount of weight a person looses in the first year after their batiatric operation.

Although I believe a Roux en-Y gastric bypass is still the best option for most patients with type II diabetes and severe gastroesophageal reflux, other patients may do well to choose a gastric sleeve operation since there is less concern about mineral and vitamin deficiencies.

Hopefully in the near future all insurance companies will include coverage for the gastric sleeve procedure.

Please see the video posting I did on this blog to better understand how the gastric sleeve procedure works.
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