LAP-BAND^® Costs and Insurance

Video Transcript 

Getting through the insurance process — and getting on with your weight loss journey.

Approvals, denials, and forms — oh my! Dealing with insurance can be intimidating for all of us. But with the LAP-BAND^® System, you’ll find the help you need to get through it all.

Determining insurance coverage

Based on market research, over 80% of actual LAP-BAND^® cases performed were reimbursed in full or in part by insurance.¹

There are several insurance companies that offer partial or full coverage for LAP-BAND^® System surgery.

To find out if your policy covers weight loss (or bariatric) surgery, refer to your policy materials. If you don't have a copy, your employer’s human resources department or your insurance provider will be able to provide them for you. Read through your benefits, looking for:

• "Covered Expenses" (or similar title): the expenses your insurance company will pay.
• "What Is Not Covered" (or similar title): costs that may not be covered by your plan.
• Any reference to coverage for weight control, or the treatment of obesity.

Some policies only cover the procedure when medically necessary. In this case, your surgery should be covered if you meet national guidelines for the care of morbid obesity.

You may also find the procedure is partially covered. This usually means your tests or hospital and anesthesia fees if you are having another approved abdominal surgery performed at the same time.

Medicare coverage

On February 21, 2006, the Centers for Medicare and Medicaid Services (CMS) published a National Coverage Determination for bariatric surgery. They determined that the LAP-BAND^® System procedure would be covered. You can read full Medicare details here.

Authorization requirements

Most insurance companies require prior authorization for weight loss surgery, as well a Letter of Medical Necessity from your doctor. This letter can be found in our Resource Center on this page. It includes:

• Your weight (at least 30 pounds overweight with one or more obesity related comorbid conditions) with your BMI (at least 40 kg/m² or at least 30 kg/m² with one or more obesity related comorbid conditions).
• A list of any weight-related medical conditions you have.
• The fact that you have been significantly overweight for five years or longer.
• The number and type of weight loss programs you have tried.

Additional information to help guide you in working with your insurance provider is available in the Obesity Action Coalition’s (OAC) brochure, A Guide to Seeking Weight-Loss Surgery, which can be found in the Resource Center on this page.

Need more help?

LAP-BAND^® System surgeons have staff members who are trained, experienced, and ready to help you verify insurance authorization for your procedure.

Once you find a certified LAP-BAND^® System surgeon, you can call our free Reimbursement Hotline at 1-800-LAP-BAND. Here our experts can give you personalized assistance with:

• In-depth knowledge of policies specific to your geographic area.
• Faster turnaround time for benefits requests and coverage verification.
• Prior authorization (PA) support, to research requirements for specific payers; assist you and your surgeon’s practice in submitting the necessary paperwork; and follow your case until a decision is made.

Or use our Am I Covered tool to see if you may be covered.