Lap Band Surgery and Medicare

The days are long gone when old-timers once looked at their overweight bodies from their rocking chairs and decided that’s just how things are and there is no use worrying about it. Can’t teach an old dog new tricks, etc. etc.

But now 65 is said by many to be what 45 used to be.

The Baby Boomer generation (everybody born between 1946 and 1964) is the first in history to travel from their teens to retirement age while:

• Engaged in mindful eating
• Making exercise a daily event
• Kicking the tobacco habit

And because they feel young, they want to look just as young. (Of course, the other noteworthy characteristic about Boomers is they invented the “Me generation.”)

Paritam, a 34-year-old Medicare carrier appeals processor posted on the LapBandTalk.com forum that retirees are being granted authorization to have the Lap Band procedure. But, alas, Medicare won’t pay for the fills.

Those “fills” are injections of salt water by a Lap Band doctor into an internal port on the patient’s abdomen. The port is connected to a ring, or “band” around the top of the person’s stomach. Injecting more salt water yields a tighter Lap Band ring and restricts the amount of food the patient can hold. Result? The pounds melt away.

The requirements for having a Lap Band procedure through Medicare, the federal health plan for retirees and some disabled, are about the same as in many private health plans.

For Medicare, patients must show:

• A Body Mass Index (BMI) of 40
• Or a BMI of 35 and one other co-morbidity like diabetes, hypertension or sleep apnea.
• A failed three-month effort at dieting and exercising
• Agreeing to use a Medicare approved surgeon and facility
• Willing to pay 20 percent of the fees

Charges for fills vary widely. Some health plans cover fills for the first or second year while some bloggers report paying anywhere from $75 to $250 per adjustment.

At a time when national conversations are largely – and, often, heatedly – about health care costs, Medicare leads the way in showing the efficiency of stopping one condition – obesity – that usually leads to other chronic illness where treatment costs are sky high.

So the cost of Lap Bands for 72 million Baby Boomers could save billions of health care bucks in the future.