Tufts Health eases policy on weight-loss surgery

Tufts Health Plan has quietly loosened its restrictions on weight-loss surgery, expanding insurance coverage for the operations and shrinking how much time patients must spend in counseling beforehand .

The restrictions had been criticized by the state Department of Public Health, patients, and surgeons even before they went into effect in March.

In a statement issued yesterday in response to questions about its new policy, Tufts said it was committed to offering its members the best chance for long-term success.

"Working most closely with bariatric surgeons at Tufts-New England Medical Center, we jointly agreed to guidelines for the coverage of bariatric surgery," the statement said.

Tufts spokeswoman Catherine Grant said the plan would not elaborate on the reasons for the change.

The revised rules, effective as of April 16, appear to address some of the concerns raised by Nancy Ridley, associate public health commissioner, who in February sent a letter to Tufts Health Plan president and chief executive James Roosevelt Jr., saying the restrictions contradicted department guidelines for obesity surgery. She warned the agency could review denied coverage .

Under the revised rules, Tufts will pay for obesity surgery for members with a body mass index above 35 if they also have diabetes, hypertension, or sleep apnea that requires treatment. Under the original rules, the minimum BMI for such patients was 40.

The health plan also dropped limits on the types of obesity surgery patients could qualify for. Now patients eligible for coverage can undergo either laparoscopic gastric banding or gastric bypass surgery.

Before surgery, members now must join the health plan's lifestyle counseling program, called iCanChange, for six months, down from 12 months under the original rules. They can continue the behavioral program for 12 months if they wish, rather than go on to surgery, the plan said.