Insurance

Will My Insurance Company Cover the Lap-Band®?

The good news is that many insurance companies realize the serious health threats related to obesity and will cover the Lap-Band® Surgery. If you discover that your insurance company does cover weight loss surgery like the Lap-Band® then you will have to determine what your out of pocket expenses will be.

These expenses will be determined by what pre-surgical tests you may need, what your co-payment or deductible may be and how much of that you may have already exhausted in the current year. You will ultimately have a consultation with your doctor and it is best at that time to have your health benefit card with you so that the staff at the doctors practice can determine to what extent your insurance will cover the Lap-Band® Procedure and what expenses you may have to incur.

Insurance Coverage

How do I confirm that my Insurance company covers the Lap-Band® Weight Loss Surgery?

You will find that weight loss surgery, specifically Bariatric surgery is covered by many insurance companies, and some insurance companies may have some very specific criteria that your must meet before they will let you have the surgery.

Criteria like a physician supervised diet, they may require a letter of medical necessity from your primary care physician, they may even require a psychological evaluation.

To determine if your insurance company covers the Lap-Band® procedure you can contact them directly via telephone. Insurance companies have a very specific code for every surgery and procedure, and the Lap-Band® procedure code is 43770, so when you talk to your insurance company representative about weight loss surgery, ask them specifically about procedure code 43770.

You can also visit your insurance companies website and look for sections under "what procedures are covered and what procedures are not covered".

Remember just because the website may say that weight loss surgery is covered that may not be specific enough so be sure to verify the Lap-Band® gastric Banding system.


How to pursue authorization

Your insurance company may need for you and your primary care physician to verify that you actually need this surgery in order to achieve better health.

If they do require this they may need a letter of medical necessity the letter will have to tell why you need the surgery and why your doctor believes it is needed.

It will have to document how long you have been overweight, usually insurance companies require that you have been overweight for at least five years.

They will ask for you to document your current weight, they will look for your weight to be at least 100 pounds over your ideal weight according to a BMI calculator. Your BMI will have to be 40 or over (or over 35 with other medical issues like type 2 diabetes, hypertension or sleep apnea)

And finally they will likely ask for a history of your past attempts to lose the weight. (failed diet and exercise attempts) As you would guess the more detailed information you include the better your chances for approval will be.

What if I get denied coverage for the Lap-Band® Weight Loss Surgery?

If your insurance company denies you coverage you do have the opportunity to appeal their decision which could take a lot of time.

You also have the opportunity to contact an attorney who specializes in insurance denials. You can find on such firm at:

www.obesitylaw.com

And finally if all else fails you can look at other payment options contained on the Payment Options page.