Will my insurance cover the LAP-BAND surgery?
As the popularity of the LAP-BAND grows, many insurance companies are now covering all or most of expenses related to LAP-BAND surgery. Numerous companies, including Aetna, Anthem Blue Cross or Blue Shield, Cigna, Emblem, HealthNet, Medica, Priority Health, and United Healthcare, cover all or portions of the LAP-BAND procedure for patients that qualify.
There are insurance companies that cover the entire cost of the surgery, but the majority will cover anesthesia, the hospital facility use bill, and the fee of the surgeon, which generally covers approximately 80% of the total cost. A standard term utilized by insurance companies is that they will cover what is "usual and customary" for the LAP-BAND. "Usual" is the standard rate charged by the service provider for the treatment and "customary" is the normal rates of the competitors in the same area. This can cause the rate to vastly differ from company to company, and co-pays can vary significantly.
Communication with insurance companies is vital, as many will be extremely clear on what is covered by your health plan. An important note to keep in mind is that even though some companies may cover the LAP-BAND procedure, many will not cover desired post-surgery procedures, including the bra-line back lift, facelift, tummy tuck, liposuction, or surgeries to remove excess hanging skin which may occur after any dramatic weight loss.
Some excellent and essential programs that are usually covered by insurance include post-surgery support groups, dietary counseling and exercise and nutrition programs.
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What options do I have if my insurance won't cover the LAP-BAND?
There are numerous actions to consider before determining what will or will not be covered by your insurance plan. Your surgeon can also provide you with a "letter of medical necessity". Be sure to note that many insurance agencies actually require this document prior to approving bariatric surgery, so keep it in mind when first talking to your surgeon. This document includes your personal information, your medical history in regards to attempted weight loss, and your body mass index (BMI). It will also detail any health issues related to obesity and how being overweight affects your daily life.
Additional letters can be an incredible help in convincing your insurance company to cover the LAP-BAND surgery. Ask all doctors and medical professionals that have treated you for obesity-related problems for documentation supporting your current state of health. It is also very important to maintain records of every attempt at weight loss, as this will all support your claim that the surgery is a medical necessity.
If paying cash is your only option, take note that there are additional costs that may not be included, including complications with the surgery, or post-surgical programs. Talk with your medical professionals, as many surgical centers offer independent insurance counseling and "reinsurance" plans that can cover potential complications. Also, numerous centers have an insurance specialist on staff that can guide you through any troubles with your agency.