Insurance Coverage for Lap-Band Surgery?
Will insurance pay for LAP-BAND?
Some health insurance carriers may provide coverage for LAP-BAND surgery. Therefore, prospective LAP-BAND patients who possess health insurance may wish to inquire about individual plan coverage of obesity-related surgeries. Use our online form to have us verify your health insurance coverage for Lap-Band surgery.
California Surgical Institute works with a number of health insurance companies who provide coverage of LAP-BAND surgery under specific plans; however, it is important to note that individual plans within each company vary greatly from patient to patient. Therefore, our office makes no guarantee of coverage under any specific insurance carrier. However, the following information may be of assistance as you research your personal insurance plan to determine eligibility.
LAP-BAND: Basic Insurance Information
Upon request, your insurance company can provide a “certificate of coverage” for your specific plan. This document may refer to the plan’s inclusion or exclusion of surgery for the treatment of morbid obesity, which is often recognized as a valid disability. To this end, it is imperative that you read the provisions of your individual plan under your insurance carrier.
If indeed LAP-BAND is covered under your individual plan, our office will work with your personal physician to establish medical necessity with your insurance company. We may request a variety of documentations in order to accomplish this, such as your medical records, proof of participation in previous weight loss programs, or relevant psychological exams.
How is medical necessity established?
Often, insurance companies adhere to guidelines established by the National Institutes of Health (NIH) when determining a patient’s eligibility for weight loss surgery coverage. These guidelines include requisites such as:
- Failure of previous weight loss attempts
- A body mass index (BMI) of 40 or greater, or
- A BMI of 35 accompanied by co-morbidity factors
Other options
If your specific policy excludes coverage for weight loss surgery, appealing this exclusion may be an option. Most often, this is possible when a patient’s personal physician recommends a certain procedure, such as LAP-BAND, as the best method of treatment for a life-threatening condition; this typically refers to diabetes, high blood pressure, heart disease, or severe sleep apnea, as they are generally covered under most insurance plans.
During your initial consultation, insurance and other payment issues can be discussed at length with one of our trusted administrative professionals.