What Health Insurance Companies Cover the LAP-BAND Surgery?

Written by James Hirby | Fact checked by The Law Dictionary staff |  

Known generically as "weight-loss" or "bariatric" surgery, LAP-BAND surgery is an increasingly popular medical procedure designed to control caloric consumption by reducing the surface area of a patient's upper digestive tract. Although it's a relatively invasive procedure that requires surgeons to cut into the patient's body cavity and make a number of adjustments to the stomach and esophagus, bariatric surgery is practiced by hundreds of surgeons across the country.

Multiple clinical studies have shown that it effectively reduces weight in morbidly obese patients during the 12-month period that follows the initial procedure. Since it has only been practiced in its current form for about a decade, its long-term effects are less clear. Anecdotal evidence suggests that many individuals who undergo weight-loss surgery may regain significant amounts of lost weight in the years following the procedure. Longer-term studies are needed to confirm this trend.

Despite these doubts, most medical professionals recommend weight-loss surgery for patients who are at least 50 pounds overweight and have been unable to lose meaningful amounts of weight using less drastic methods. Unfortunately, the procedure can cost tens of thousands of dollars for patients without adequate insurance coverage.

To make matters worse, even some patients who do carry health insurance may not qualify for the procedure. Several national insurance companies make a point of covering weight-loss surgery in cases of "medical necessity." This means that only those patients who face imminent death or disability related to obesity can qualify for the procedure. Using this definition of "medical necessity," morbidly obese patients who remain able to perform everyday tasks may not qualify.

Certain insurance companies may be more lenient in this regard. If you're unsure whether your insurance provider will pay for most or all of your expenses related to bariatric surgery, check with it directly. You can either call its national hotline or find information about your specific plan on the company's website. Alternatively, you can look for the applicable information in a hard copy of your plan documents. Coverage information is usually contained in the section of your plan that outlines "covered" or "uncovered" conditions.

If you're unable to determine whether your health insurance plan covers bariatric surgery, you may need to contact the makers of the LAP-BAND surgery system. You can find more information about the system's designers at lapband.com. If you determine that your health insurance provider doesn't cover this procedure, LAP-BAND may encourage it to do so.

More On This Topic



Comments are closed.