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Lap Band surgery insurance information
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.
- BMI requirements.
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 .
- Multidisciplinary program?
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.
NOW WHAT?
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
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