Lap band surgery--insurance coverage?

Neeraj Gupta

Lap band surgery is really very expansive weight loss surgery. The cost of lap band surgery include the cost of consultant with surgeon, cost of pre-operative test, hospital and surgery cost, cost of post-operative test, anesthesia fees, lap band adjustment exercise and diet counseling, lab and x-ray fees and miscellaneous fees. In a combined way this is really too much for anybody and if you are going out from your native place for lap band surgery then cost add travel charge, fooding, lodging and others. Wow….



Generally cost of lap band surgery in average is $25,000 without any complication and double if there are. So before going to lap band surgery really determines the cost which really count a value. It is right that it is low in the sense to gain beautiful figure and to get rid from other disease which often caused due to obesity. But you have to look after your pocket also. Most of can afford lap band surgery. For some lap band surgery can afford by their insurance company. Many peoples meet the qualifications for Medical aid or Medicare assistance which covers the cost of lap band surgery. Sometimes they will pay entire bill, sometimes a co-payment is required. For that you have to assure that you have limited source of income and other requirements like-age, physical disabilities, citizenship and other resources. Your age must be 65 or older (under 65 with certain disabilities).



Nowadays lap band surgery is legally permitted so most of insurance company allow for it. Lap band surgery insurance coverage depends on person and insurance company. It differs from person to person. First check your insurance plans cover lap band surgery or not. It varies between insurance plans. Check whether this plan cover surgery or complication of surgery that is partial coverage. Companies either partially or completely cover lap band surgery. Properly check that how much amount they cover.



There are some requirements for insurance coverage on lap band surgery. For the prior authorization A letter of medical Necessity and weight loss history are needed. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information---



  • Patient´s weight which should be 100 ponds or more than an ideal weight.


  • BMI should be more than 40 (more than 35 with associated problem to qualify).


  • Obesity related problem list like-type 2 diabetes, sleep apnea, hypertension etc.


  • Number of years patient has been overweight (must be at least 5 or more).


  • Number and types of attempted failed weight loss program.


  • Attach medical records of weight loss efforts.


  • With these requirements you are ready for insurance coverage. If coverage has been denied upon the initial prior request you can appeal by addressing the specific reasons why your request has been denied. Your surgeon can help you in this process. If you failed to get insurance coverage then you can go for an alternative way that is patient financing. Ask to your surgeon about patient financing program available through his or her office. If you self pay, you may want to discuss with your doctor and your insurance company if this will affect your insurance payments in futures.



    In any case for insurance coverage for lap ban surgery, you should consult to your surgeon and insurance company.
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