We received some great news from the Ohio chapter of the American Society of Bariatric Surgery regarding weight loss surgery and CareSource. Up until now, no insurance company has covered bariatric surgery when the patient’s BMI is below 35. Now, however, CareSource has updated its policy to cover gastric sleeve and gastric bypass for patients in the 30-35 zone if they have uncontrolled diabetes. Their definition of “uncontrolled” is a hemoglobin A1C of 8 or greater.
In addition, they have added the following medical conditions as “weight-related medical issues” that can be used to potentially qualify for surgical weight loss:
- Non-alcoholic fatty liver disease
- Nonalcoholic steatohepatitis (NASH)
- Pseudotumor cerebri
- Gastroesophageal reflux disease (GERD)
- Venous stasis disease
- Severe urinary incontinence
- Debilitating arthritis
This is great news as it will significantly open access to care for many CareSource patients. We can only hope that other carriers will follow suit!