Monday, January 12, 2015

Big News for Utah Medicaid WLS Patients! Coverage of Sleeve Gastrectomy, and no more "6 month" penalty lap

Wow - thanks so much to advocates from all sides. Patients, caregivers, public servants, companies, and the Obesity Action Coalition and ASMBS are all working to obtain equal access to care for obesity.

See below for their quote,

"Utah Medicaid follows McKesson InterQual 2014 criteria for surgical procedures. Within this product, the supervised weight loss criteria point is no longer there. It has been reworded now to be "documented history of weight management attempts" and "unable to maintain sustained weight loss." With that said, we would not require a "medically supervised" diet for any length of time. Utah Medicaid would only require documentation of weight management attempts and failure to maintain sustained weight loss. In conclusion, this places the responsibility on the provider to make sure they document these weight loss attempts. It also allows for them to use their own discretion for the appropriate length of time a patient should attempt these weight management programs. "

Anyone feel like writing letters to Intermountain Healthcare or PEHP to make their coverage as good as Medicaid and Medicare? The time for discriminatory plan design is OVER! (but not without careful monitoring of how things are implemented...)