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Medicare changes coverage for weight loss surgery

October 10, 2013

People have lost a lot more than pounds and inches following weight loss, or bariatric, surgery. Some have found themselves without high blood pressure, joint pain, diabetes, and the medications they took for those problems. “To suddenly no longer have a serious, chronic condition like diabetes is amazing,” says Janice Berguetski, director of St. Mary’s Bariatric Surgery Center.

Recently Medicare, the federal healthcare program for disabled and elderly Americans, changed the way it looks at weight loss surgery. “Previously, Medicare covered the surgery only if it was done at a facility certified as a metabolic and bariatric surgery ‘center of excellence,’” Berguetski says. Certification by the American Society for Metabolic and Bariatric Surgery and the American College of Surgeons is based on the number of procedures a facility does. For bariatric programs in small communities, like ours, those numbers were fairly ambitious, she explains. Medicare realized programs in smaller communities were showing excellent patient outcomes and removed the center of excellence requirement for coverage.

Some private insurers still require center of excellence status, and, as an experienced bariatric program with excellent patient results, St. Mary’s is pursuing certification.

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