Do Insurance Companies Cover Lap Band Surgery?

When you plan to have lap band surgery, one important factor you have to consider is how you are going to pay for the weight loss surgery. Insurance coverage for Lap Band surgery is normally granted or denied on an individual basis. For this reason, you have to be aware of your particular insurance provider's policies.

When reviewing your insurance policy, you should look at the area in your policy that states: "What Is Covered" or "Covered Expenses." These are the healthcare benefits that the insurance provider will cover. In this section, search for a statement that says the provider excludes coverage for "weight control, for the treatment of obesity, for the surgery for weight control, or for the complications of the surgery for weight control." Some providers will state they exclude all forms of weight loss surgery while others will state certain areas that they will provide coverage. For instance, they may state they will cover "when deemed medically necessary." The policy will likely state certain conditions that must be met. You need to find out about their exact conditions.

You should also check to see if you can get partial coverage. There may be a way to have some areas associated with the lap band process covered such as hospital fees.

The following is a list of insurance providers that either partially or completely cover Lap Band surgery:

Blue Cross (some states)
United Healthcare
Oxford Health Plan
Medicaid
American Family Insurance
Humana
First Health
One Health
Tufts Health Plan

One will require a Letter of Medical Necessity and a history of your weight loss attempts in order to be granted coverage for the surgery. The following information is usually included in the Letter of Medical Necessity:

A weight that should be 100 pounds or more above your ideal weight.
List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.
Number of years that you have been overweight (at least five or more)
A detailed list of all your weight-loss attempts

Source: lapband.obeseinfo.com.

Most insurance companies will rely on the National Institute of Health (NIH) guidelines to determine if a client should have weight loss surgery coverage. The NIH guidelines state that weight loss surgery may be an option for patients who "1) have failed with other weight loss treatments and 2) have a BMI of 40 or greater, or have a BMI of at least 35 and co-morbidities."

If your insurance plan has an exclusion listed for weight loss surgery, you may still be able to get approval. You will have to appeal the exclusion and get a letter from your physician stating that lap band surgery is the best method of treatment for your life-threatening condition. Such health conditions can include: diabetes, high blood pressure, and heart disease. You may possibly get approval for weight loss surgery as a treatment for one of these health conditions.

Lap band surgery is an expensive weight loss procedure. If obesity is a serious health risk, it is important to check with your insurance provider to see if you are covered.

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