Menu button
ASMBS Logo

Posted 9/5/2019

September 2019 Edition

1. Letter From the President

Dear ASMBS members:

This is among the most exciting messages I will share with you during my Presidential term. The information comes to us as an update from our Access to Care (ATC) Committee, chaired by Dr. C. Joe Northup (OH), co-chaired by Dr. Mickey Seger (TX) and Dr. Margaret Inman (IN), with the assistance of Executive Council Liason Dr. Teresa LaMasters (IA). This committee’s mission is the very important objective to broaden access to metabolic bariatric surgery for our patients. The ATC committee is very large (more than 80 members) and these members work hard to influence payers and other stakeholders about the value and cost-effectiveness of our surgical procedures. Yet often we see little change in coverage despite their constant unrelenting efforts.

C. Joe Northup, MD, Access to Care Committee Chair

The big news is that overall, and for the first time, we are seeing some payers dropping their arbitrary 6 month pre-operative dietary requirements while also seeing exciting progress on Low BMI coverage. We have had several insurance providers reduce their requirements or expand indications for bariatric surgery in the past few months. The following is a listing of some of the major companies and areas that have been impacted.

Michael Seger, MD
Margaret Inman, MD ACS
1. Changes in pre-operative insurance-mandated diet requirements

Cigna Insurance
A statement from a physician or physician extender (other than the requesting surgeon) that the individual has failed previous attempts to achieve and maintain weight loss by medical management. Replaced: Participation in a consecutive 3-month dietary program within the past 12 months Effective 7/15/18

BCBS of Tennessee
Removed language requiring fixed length pre-operative weight loss requirement. Now requires: Attempts at non-surgical weight loss program within the previous 2 years Weight has either remained stable or decreased Non-surgical programs have not achieved desired weight loss
Effective 1/3/19

United Health Care (30 Million Covered Lives)
Removed 6-month pre-operative diet.
Changed to “Participation in a multi-disciplinary preparatory regimen”

2. Expanded indications for surgery allowing coverage for Low BMI patients

Dean Health (Wisconsin- 346,000 covered lives)
Added coverage for bariatric surgery for patients with BMI 30.1-34.9 with Type II Diabetes and fails to maintain a Hg A1C of <8% with medical therapy
Effective 6/1/19

Prevea 360 HealthPlan
Added coverage for bariatric surgery for patients with BMI 30.1-34.9 with Type II Diabetes and fails to maintain a Hg A1C of <8% with medical therapy
Effective 5/19/19

Arise Health Plan (Wisconsin- Covers 85,000 Lives)
Added coverage for bariatric surgery for patients with BMI 30.1-34.9 with Type II Diabetes and has a HgA1C of >8%
Effective 7/1/19

UHA Insurance (Hawaii- 62,000 Covered Lives)
Added coverage for bariatric surgery for patients with BMI 30.1-34.9 with Type II Diabetes and has participated in a comprehensive pre-operative program. Only will cover Roux-en-Y Gastric Bypass for these patients
Effective 10/16/18

Caresource Ohio Medicaid
Added coverage for bariatric surgery for patients with BMI 30.1-34.9 with Type II Diabetes and has a HgA1C of >8% *Policy name changed from “Obesity Surgery” to “Metabolic and Bariatric Surgery in Adults 20 and Older”
Effective 10/1/19

Connecticare Commercial (Connecticut- 190,000 Lives)
Added coverage for bariatric surgery for patients with BMI 30.1-34.9 with Type II Diabetes and has a HgA1C of >8%
Effective 10/1/19

Select Health of South Carolina (364,000 Lives)
Added coverage for bariatric surgery for patients with BMI 30.0-34.9 (27.5 to 32.4 BMI in Asian Americans) with Type II Diabetes and has a HgA1C of >7% despite optimal treatment
Effective 5/7/19

I need to recognize and thank many other members for their contributions that have made these changes possible including Dr. John Scott (SC), past chair of the ATC Committee. It is particularly important to thank the many local members of ASMBS who have fought for these changes in their home states, including the ASMBS STARS and SUPER STARS (State Access to Care Representatives) in each location. Finally, I must also thank Joe Nadglowski (OAC CEO) who has been leading the tireless efforts of the Obesity Action Coalition, the organization that represents our patients with over 60,000 members who are constantly advocating for improvements in access to care. OAC filed several lawsuits in New York on the grounds that arbitrary diet requirements mandated by insurance companies discriminate against patients suffering from the disease of obesity leading to several companies dropping that requirement.

Please join me in congratulating all who work towards improving access to care for our patients. You can find the appropriate individual to thank via the following web link:
asmbs.org/committees/access-to-care-committee

Finally, I hope all of you are aware that ObesityWeek registration for our Annual Meeting in Las Vegas November 3 – 7th is now open. Although registration opened a few weeks later than past years, I am pleased to report we already have over 3,000 people registered to attend! This is going to be a phenomenal meeting featuring a tremendous number of topics including our special focus on surgical treatment of Type 2 Diabetes. We all need to continue our focus on raising awareness of the beneficial impact of surgery on diabetes as we gain momentum in our efforts to leverage insurers to provide better coverage for this valuable treatment intervention. However, we can also take some time to celebrate our victories, and I propose we get together to do so in Las Vegas!

Please use the following link to register for the meeting:
ObesityWeek.com/Registration

Eric J. DeMaria, MD, FASMBS
ASMBS President

2. National Obesity Care Week

Join ASMBS as a Champion of National Obesity Care Week!

ASMBS is a Founding Champion of National Obesity Care Week (NOCW) that envisions a society that understands, respects and accepts the complexities of obesity, and values science and clinically-based care.

NOCW 2019 is taking place September 15th to 21st with a focus on access to comprehensive obesity care, including bariatric surgery. As an NOCW Champion, you can help spread awareness about the importance of access to care and barries that patients face. NOCW and its Champions also believe that:

  • People with excess weight or obesity deserve access to care without barriers
  • People with excess weight or obesity must be treated with dignity
  • People with excess weight or obesity must be treated with respect

As a member of ASMBS, your voice and support of NOCW is vital in improving access to care for all individuals affected by obesity.

If you or your practice is interested in becoming an NOCW Champion, please contact Katie Thrasher at the Obesity Action Coalition via email at kthrasher@obesityaction.org.

3. ObesityWeek Networking & Social Events

With less than two months to go, we’re giving you our list of must-attend ASMBS networking opportunities and social events at the Annual Meeting at ObesityWeek! There are many ways to get involved this year, including our evening International and Practice Building receptions. Join the ASMBS Foundation for their 2nd annual Gala & LEAD Awards on Thursday night. Your registration to the Scientific Sessions also includes admission to the Vegas AfterDark closing party to round out the conference.

International Reception: Join ASMBS, the ASMBS Foundation and IFSO for the International Reception, a time dedicated for guests who came great distances. This networking session also serves as a cocktail reception, and the winners of this year’s International Awards will be recognized at the event.

Practice Building Reception: Come for the food, drink, and camaraderie of colleagues who share the interest of building their practices! ASMBS gratefully acknowledges our supporters of this reception.

Foundation Gala & LEAD Awards: Join the ASMBS Foundation for their 2nd annual Gala & LEAD Awards this November during ObesityWeek. Together we will pay tribute to the generous supporters of the Foundation, and honor leaders in the field of metabolic and bariatric surgery! Tickets are now on sale and can be purchased online at www.ASMBSFoundation.org/lead. Proceeds from this evening will support the Foundation’s mission to fund ASMBS Research Grants, Educational Programs, and Access to Care initiatives.

Vegas AfterDark: Relax, unwind, and celebrate all that you learned at the conference with friends and colleagues at the Vegas AfterDark Reception. This exclusive closing party offers live music and dancing to wrap up the final night of the meeting. Admission is FREE for all ASMBS members who have registered for the Scientific Sessions. Additional guest tickets are available for purchase. Not an ASMBS member? Stop by our Membership Marketplace during the conference for a complimentary ticket and to learn more about other benefits of joining the Society!

More information about ASMBS Highlights can be found at ObesityWeek.com

4. IH Presidential Message

Summer is over, school has started, and ASMBS is busy, busy, busy.

Hot off the press… the Integrated Health (IH) Communications Committee has recently developed a poster for members to display in the office, waiting room, exam room(s) or any other area. The poster is designed to let patients know the employees of your program are proud members of ASMBS – and let them know the valuable work of the Society. The poster is provided FREE of charge from ASMBS as a download. The download is in PDF format and can be reprinted as a poster by the printer of your choice. You may also purchase a 18×24" wall poster to have conveniently displayed in the office. To download or order yours, please visit the ASMBS Online Store.

Nominations, nominations, nominations. Please watch your emails for Integrated Health nominations. The nominating committee is requesting the IH membership to submit nominees for IH Executive Council (IHEC) Member-at-Large (MAL) positions. Additionally, we are inviting you to submit nominees for the Certified Bariatric Nurse Award, and will soon send emails for nominees for the Advanced Practice Provider and Behavioral Health Awards. If you know of an ASMBS member who meets the criteria for any of the awards or the IHEC MAL positions, please consider nominating them. We need your help. Visit any of the following links to submit your nomination(s):

IHEC Member-at-Large
Certified Bariatric Nurse Award
Advance Practice Provider Award
Behavioral Health Provider Award

Please also mark your calendars for the Certified Bariatric Nurse Review Course to be offered at the Florida State Chapter meeting in October. If you have staff or colleagues who are considering certification as a bariatric nurse, but will not be attending the annual conference, here is an opportunity to attend a review course.

Finally, the ASMBS Annual Meeting at ObesityWeek is rapidly approaching. The IH Professional Education and Program Committee has developed an agenda with topics that will appeal to many. Please be sure to register and book your room early. I look forward to seeing you in Vegas!!

Karen Flanders, MSN, ARNP, CBN
ASMBS IH President

5. OCAN Advocacy Day

On Friday, September 20th, the Obesity Care Advocacy Network (OCAN) will host its Fall Advocacy Day on Capitol hill in conjunction with National Obesity Care Week (NOCW). Capitol Hill visits take place 9:00am to 2:00pm and attendees will be focusing on increasing cosponsrship for TROA as well as educating offices about the goals and mission of NOCW. Click here to register now.

Your browser is out-of-date!

Update your browser to view this website correctly. Update my browser now

×