Does Insurance Cover Lap Band Surgery?

As I’ve blogged recently, I’m spending some time reading questions about lap band and bariatric surgery being asked at Yahoo! Answers. Sometimes, though, it’s the answers to these questions that really puzzle me. One question that comes up frequently is from people wanting to know does insurance cover lap band surgery.

Does Insurance Cover Lap Band Surgery?

There is a LOT of mystery concerning weight loss surgery out there, and by gum, I’m gonna do my best to set America straight!

does insurance cover lap band surgery ?

photo credit Thomas Hawk, flickr

Does insurance cover lap band (bariatric) surgery?

This question is asked frequently, and is frequently answered quite incorrectly by people who mean well but don’t know. Some people hold the baseless opinion that bariatric surgery is cosmetic surgery, and as such is never covered by health insurance. This is patently false. The benefits of weight loss surgery can add years and quality to your life. Your blood pressure will drop, your risk of diabetes can practically vaporize. Some health insurers recognize this and provide the bariatric surgery benefit. What’s better, cover a $25,000 procedure now, or $500,000 in cardiac care later?

But back to the answer: it depends on

  • what quality of coverage you have (not all plans by the same company are the same!)
  • what company your coverage is through
  • what your Body Mass Index is

The most important determining factor if your insurance cover lap band surgery is your BMI, or Body Mass Index. I’ve located a good online BMI calculator here. If you’re not morbidly obese (BMI of 40 or higher), even if you do have a plan that does cover bariatric surgery, surgery will not be authorized. Further, many doctors won’t agree to perform the surgery in the first place for ‘merely’ overweight patients.

I’ll spare you my personal thoughts on for-profit health care and for-profit health insurance, and get right to it. In order to know if you do enjoy a weight loss surgery benefit, you have to connect with your carrier and find out.

Beyond your BMI, your personal circumstances will rarely figure into the equation. If you’re not in the morbidly obese category, practically zero insurers will cover bariatric surgery. If your plan does cover bariatric, then there is a light at the end of the tunnel and you can move forward with investigating bariatric surgery.

BMI calculator

While it is true that if your health insurance cover lap band surgery, it’s up to you and your doctor to decide which procedure is best for you (lap band, gastric bypass aka Roux-en-Y, gastric sleeve, or another). Additionally, it is quite common that the health insurer require that you drop a certain percentage of weight on your own before permitting the surgery.

If you think about it for longer than two seconds, this requirement is silly. I am willing to bet that every obese person you see has lost a fair amount of weight at one point in their life. Losing weight is not the problem. The problem is keeping the weight off and not gaining it back. Helping you keep the weight off is where weight loss surgery excels. Is this same logic applied to other symptoms and surgical procedures?

“Mr. Johnson, before we authorize your lung surgery, we’re going to need you to quit smoking for six months. Then and only then will we financially authorize the surgery to be performed to save your life.”

Do insurance companies require smokers to stop smoking in order to treat their disease(s)? No, they do not.

What if Insurance does not cover bariatric surgery?

If your health insurance plan does not cover bariatric surgery, all is not lost. You can appeal the decision. Your weight loss medical team have gone through this process with countless other patients who were turned down, and they might be of help to you as well. I was impressed with Swedish Hospital’s Weight Loss and Surgery Center and went with them, they offered a discount for self-payers. The itemized bill came and my surgery would have cost $35,000 or more, but the Center has an arrangement with Swedish Hospital, and the cost of surgery and one year’s worth of follow up care was $18,000. This arrangement brought the cost down significantly, but it’s still a large chunk of change. Consider a home equity loan, loans from family members who would love nothing more than to see you healthy and happy, consider a personal loan or new line of credit.

The benefit of paying for it yourself? Less hoops to jump through means you can schedule your surgery quicker! Your insurance provider, being removed from the loop, will not need weeks to review your case waiting to receive approval. Not needing insurance to cover lap band surgery: priceless.

Do you have a question regarding bariatric surgery, or the lap band? Or, do you take exception with the information I’ve provided here? Let me hear about it in the comments section below!

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What do you think?

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