Most insurances are now offering coverage for the Lap-Band surgery.

At one time it was considered more of an elective surgery; however more and more insurances are now treating Lap-Band surgery as a “medical necessity.”

When working with your insurance they will require proof of medical necessity. What this means is that they have set up a criteria that outlines what would make surgery medically necessary for you.

In order for Lap-Band to be considered medically necessary, most insurances require that you have a body mass index (BMI) of 40 or greater. They may still consider you for surgery with a body mass index of 35-39, but you would have to prove that you have at least two co-morbidities.

Your body mass index in measured by factoring your height against your weight. You can check your BMI using our BMI calculator.

What are co-morbidities?

Co-morbidities are diseases tied directly to the patient’s obesity such as diabetes, hypertension, high cholesterol, sleep apnea, coronary issues, and pulmonary issues to name some. You will notice these diseases can be considered “life threatening.”

Nearly 96% of the insurances that I have worked with require that the patient complete a “medically supervised diet”. The length of the diet depends on the insurance company, but it can be anywhere from 3-6 months in duration.

One of the most common questions that I am asked in regards to this diet is “what if I lose a lot of weight during this required diet”? In answer to this question; insurance companies will factor in your weight taken at your initial consultation. This is the actual documentation that will be submitted to your insurance company for review.

Another thing to consider is this: if you could lose enough weight to no longer be considered at least obese if not morbidly obese in three to six months, you probably would not be considering the Lap-Band surgery. I have yet to see a patient fall off of the “insurance measure” of medically necessary on the required medically supervised diets.

Ninety-nine percent of the insurances I have worked with also require a psychological evaluation and clearance as well.

Some insurance require 3-5 years of documented weight history from a physician.
You can obtain these records by requesting progress notes from your primary care physician or in the case of female patients your gynecologist as either of these should have taken your vital signs which include weight.
Keep in mind if you are trying to use records from you OB/GYN you can not use records that note your weight during pregnancy.

A good way to begin the process of finding out whether or not your insurance covers the Lap Band Surgery is to call the customer service phone number listed on the back of your medical insurance card and ask the representative if you have coverage for “the surgical treatment of morbid obesity”. They will tell you if it is a complete exclusion on your policy or if you have coverage after providing proof of medical necessity.

Once you know that you have coverage just call us here at DayOne Health and set up your initial consultation. You can also request a one-on-one consultation through our website. If you would like to hear more information about insurance coverage of the Lap-Band procedure, call me at 312-255-1900.

Call us today. This could be DayOne of a healthier you. We are waiting to hear from you.

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