Lap Band and Insurance Companies

Kathleen Weaver, a high school teacher in Dallas, Texas, writes the blog, Living with Diabetes and Lapband.

She recently blogged that, according to a case manager overseeing her procedure, all the insurance company paperwork needed for her Lap Band procedure had been snail mailed into the company.

And so begins a journey for Kathleen that may go as smooth as silk or turn into an excursion through Alice in Wonderland.

(A total aside: one reason the U.S. health care system soaks up so much money, time, patience and sometimes, health itself, is because it is still paper-based and not electronically automated.)

Back to Lap Bands: Depending on the insurance company, the requirements for having the procedure covered vary widely.

A cash patient can visit a weight loss doctor, show that he or she is mentally balanced, qualifies with a sufficiently high body mass index (BMI) and perhaps has other co-morbidities like hypertension and/or type II diabetes.

And then it’s on to surgery after the usual lab tests.

But getting Lap Band surgery can be different with various insurance firms.

While one company can complete the clearance process in three to six months, others have requirements that can take two to three years.

Some ask for psychological and nutritional counseling and treatment records for as long as five years.

Some require all the paperwork to show the patient has tried, and failed, from two to four medically supervised weight loss plans.

Others set the BMI bar at 36 on up and then require evaluations from bariatric surgeons and psychologists.

So if you start seeing a lot of roadblocks, it just could be your insurance company is looking for a convenient out to deny the surgery.

Sometimes, the actual providers can turn away otherwise perfect candidates for Lap Band surgery.

One group advertises a low price for the cost of Lap Band, somewhere around $10,000 (although charging much more in the end) and then herding many overweight patients into a group setting where a doctor addresses the audience to save time.

But most Lap Band candidates – who have already done a lot of research about the solution –want a one-on-one consultation. Often, a caring relative virtually drags the potential patient in for the consultation.

In the United States, the cost of Lap Band surgery ranges from an unrealistic low of $10,000 to as high as $28,000.