One of the big questions often associated with Lap Band surgery is if it is covered by insurance.
At TopSurgeons, office staff will work with you to make the insurance process as smooth as possible.
Lap Band Insures Success
The majority of major insurance companies cover Lap Band surgery as long as the candidate meets their requirements. Your insurance may consider you a candidate for the procedure if your Body Mass Index (BMI) is at least 35 (with two underlying health conditions) or a BMI of 40 or higher (with no underlying health conditions present).
The best way to determine if your insurance will cover the surgery is to reference the insurance policy package you obtained following the payment of your first premium or provided through a plan under the direction of your employer.
Generally, there are two sections that detail the extent and limits of coverage. The first is normally labeled "What Is Covered" or "Covered Expenses." These are the healthcare benefits that fall under company coverage. The other section will be labeled "What Is Not Covered" or "When the Plan Does Not Pay Benefits." In this area, search for any statement that the company excludes coverage for weight control, for the treatment of morbid obesity, or for the complications of the surgery for weight control.
Other Insurance Options
Some policies will outright not allow for coverage of Lap Band surgery while others may offer some coverage. There may be coverage if the surgery is viewed as medically necessary, allowing for patients who have morbid obesity to proceed ahead.
Another option to check into is if you can receive a portion of the coverage by having some tests covered or having another (approved) abdominal surgery done at the same, thereby giving you some coverage for things like anesthesia and hospital charges.
Among the companies that have generally covered all or a portion of Lap Band surgery are Blue Cross, Blue Shield (not in all states, check with your provider), Humana, First Health, Aetna, Health Net, Cigna, United Healthcare, Medicaid and American Family Insurance.
In order to get things started with your insurance application, a letter of medical necessity and weight loss history are needed to acquire prior authorization for Lap Band surgery. Among the items included in the letter will be your BMI information and a detailed history of the previous weight loss programs that you tried.
If your insurance coverage for Lap Band surgery is denied, you have the right to appeal the denial.
For those who do not have insurance, do not meet the insurance requirements, or have an exclusion in their policy, there is the option for easy payment plans to allow for the surgery. The payment plans offer low interest rates and low monthly payments.
For more information about Lap Band, call 1-800-953-5000.
