We can help you determine if your insurance will potentially cover the Lap Band surgery for weight loss. Even though weight loss surgery is shown to be medically beneficial to seriously overweight people, not all insurance policies will pay for the cost of Lap Band surgery.
We recommend the following steps to determine if your insurance policy may pay for the Lap Band surgery.
Call the customer service number on your insurance card. Tell the representative "I am calling to check on policy benefits. Is surgery for morbid obesity a covered benefit? Specifically I am calling to check for coverage of the Lap Band procedure, CPT code 43770." If they say yes, ask them "What is required before authorizing surgery?"
Some insurance policies have outright exclusions.
If you are told your insurance policy won't cover the Lap-Band, click here for Lap Band surgery cost.
Often representatives may say "I don't have that information. You can look up the medical policy bulletin on our website or refer to your booklet." If so look it up and get the required information. Sometimes the representative may say "All you need is a letter of medical necessity from your primary doctor." We have found this to almost never be true and you will eventually find almost always there are specific criteria to be met before the Lap Band will be covered.
Get the following requirements from either the representative or your your medical policy:
There are the possible requirements for weight loss surgery that you should ask your insurance representative about or check your policy manual for.
Some policies will only cover if your BMI is over 35 or 40 with comorbidities.
Nutrition consultation with a dietician?
Psychological consultation and clearance?
Diet history or prior weight loss attempts?
If yes, do you require a medically supervised diet (diet and exercise plan documented by a doctor in your chart) or is a plan like Jenny Craig or Weight Watchers accepted?
Documentation of prior weight history?
Many insurance companies require a '5 year weight history' which is documentation of your weight in doctors notes for each of the past five years.
Some insurance companies require a 3 to 12 month preoperative 'multidisciplinary program' meaning you may have to meet monthly with a dietician, primary medical doctor, and/or psychologist prior to surgery.
There may be more criteria, please list any that are required.
1) Get all of your medical records for the past 5 years. Filling out a release of information form for us to obtain your records is helpful, but in most cases your other doctors will release your medical records to you quicker than the time it takes to mail it to us.
2) Get all copies of weight loss attempts, such as weight watchers, jenny craig, etc.
3) If possible, get a letter of medical necessity from your primary care phyisician, or another doctor who is treating you for weight related issues.
4) If your insurance company requires new consultations, such as a psychological evaluation, or a nutrition evaluation call us as soon as possible so that we can help you schedule these. Ideally you want to complete all requirements BEFORE your appointment with us.
5) Call to schedule an appointment