Will Insurance Pay For My Lap-Band?
If you have health insurance that covers more than just extreme emergencies then the chances are good that your insurance will pay for your Lap-Band ! You will have to check your specific plan and coverage details but the truth is that most insurance plans cover bariatric surgery – including Lap-Band – because they understand the medical necessity of it and that helping you reduce your weight now will save them money on obesity related illnesses in the future.
To start with, you should either call up your insurance provider or check their website to see if Lap-Band surgery is covered or excluded in your policy. If you find it is excluded, don’t give up hope yet since you may be able to upgrade to a plan that does include this coverage at the next open enrollment period. When searching your insurance company’s website, you can put in the name of a Lap-Band surgeon in your area that you know performs Lap-Band and see if the doctor comes up as “in-network.” If he or she does, most likely the surgery is covered.
If insurance will be paying for your Lap-Band surgery, you will want to know what your out of pocket costs will be and what requirements you will have to meet before being eligible for the surgery. Some of the most common requirements for insurance approval include:
- 6 month physician supervised diet
- 5 year history of obesity
- At least 2 obesity related co-morbidities such as high blood pressure or sleep apnea.
- A psychological evaluation
- A nutritionist consultation
- A sleep study
- A chest X-ray, EKG, various other blood work
This is by no means an exhaustive list, nor should you assume your insurance provider will require every one of these tests, but it is not uncommon for some or all of them to be necessary. As for costs, it will depend on your personal deductible and coinsurance amounts, however, it is not uncommon for your insurance to cover the bulk of the surgery costs while you pay some or all of these pre-operative expenses.
The first step is always to research and find a surgeon. Once you have done so and attended an information session at his or her office, you will be able to book a consultation. You can increase your chances of the surgery being covered by insurance if you make sure the surgeon you are visiting is “in network” however, if you have “out of network” benefits you may be able to choose any surgeon you like and file for reimbursement afterwards. Bring your insurance card with you when you visit the surgeon so the office staff can begin coordinating your benefits.
Once you have completed all of the requirements, your surgeon’s office will file for approval with your insurance. If you are approved on the first try, you will be given a surgery date. If you are denied, don’t lose hope. You can always appeal the decision and many times people who were initially denied can win approval just by filing an appeal and providing additional documentation of the medical necessity of the surgery. Sometimes the appeals process can take time and you should also be aware that you can turn to an attorney for legal help. The website “obesitylaw.com” is a good resource for this if you require it.
Ultimately, getting insurance approval for a Lap-Band procedure can range from extremely quick and easy to very long and tedious. By choosing a surgeon who is “in network” for your insurance provider, you will already be a step closer. It will also be important to work closely with your primary care physician when it comes to documenting your history of obesity and weight loss attempts as well as a period of supervised dieting if necessary.
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