Gastric Lap-Band Insurance
Am I Covered?

Gastric Lap-Band Insurance

There's no good answer to the question everyone wants to know...

...will my insurance cover my gastric banding surgery...

...except...MAYBE.

Gastric Lap-Band Insurance: Keep Good Records

Buy a notebook...

...and get ready for the ride!

You'll be getting a lot of information (and sometimes conflicting information) so make sure you start the insurance process well prepared and organized. Buy a notebook you can designate to keeping track of insurance information.

Keep meticulous records of all your conversations with your insurance company. Document every call. Record:

  • the date and time
  • the first and last name of the person you spoke with
  • what you spoke about

You'll be glad you did!

Gastric Lap-Band Insurance Coverage: The First Step

Dig out your insurance policy. Read the section called "What is Covered/Covered Expenses" and "What is Not Covered/When the Plan Does Not Cover Benefits." Or simply call your Human Resource representative at work or your insurance company directly to inquire!

Find out if your policy covers bariatric surgeries and if so, which ones. If you find out weight loss surgery is covered "only if deemed medically necessary," find out exactly what that means and what documentation you'll have to provide in order to prove it.

If you're required to provide a letter of medical necessity, make sure you find out exactly what information needs to be included in that letter. Be as thorough as you can...no cutting corners! It might feel like a hassle to gather all the necessary information, but appealing is going to be a bigger hassle if you get denied.

A letter of medical necessity may need to include (but might not be limited to) the following:

  • Your weight
  • Your BMI
  • List of your medical problems associated with obesity (diabetes, reflux, sleep apnea, high blood pressure, etc.)
  • How many years you've been overweight
  • Number and types of (failed) weight loss attempts in the past

Gastric Lap-Band Insurance Coverage: List of Past Weight Loss Attempts

Here again, try to find out exactly what information you need to provide. If you don't get a clear answer from your insurance company, my advice is to OVER DELIVER. Provide more information than you think you need to.

You'll often only be told to provide your "diet history" with no explanation of what that means, only to be denied coverage because you didn't provide enough detail.

There is a huge variance in the "diet history" insurance companies require. Here is a small sampling:

  • Last 2 years of diet methods documented
  • 6 Month diet history
  • 1 year of Dr. supervision with monthly weigh-in
  • 2 years physician monitored weight loss attempts
  • Must have a medically supervised diet for six months and lose 5% of the weight with no help of drugs

If you can't get a specific answer from your insurance company, spend a lot of time making a list of all the past diets you've tried. Include dates, names of diets or diet programs, length of time you followed each, how much you lost, and how long you kept the weight off.

Include:

  • Self-attempted diets
  • Commercial diets
  • Medically supervised diets
  • Any over-the-counter weight loss aids you've used (appetite suppressants, Metabolife, Alli, etc.)
  • Any prescription weight loss aids you've used including name of the drug, name of the doctor who prescribed, how long you used it, how much you lost, and how long you kept the weight off.

If you have any records from past diet programs (food logs, menus, etc.) include those too. Get medical records of your weight-loss efforts from your doctor(s) if you have them.

Dig out those old receipts from the purchase of exercise equipment, gym memberships, or diet programs such as Weight Watchers, Jenny Craig, Nutrisystem, Overeaters Anonymous, TOPS, and any other documentation that shows your attempts at weight loss over the years.

Remember...OVER DELIVER in this area! This will be a pain in the butt, I know, but it may substantially increase your chances of being covered. Bariatric surgery is considered a last resort treatment and will not be covered unless other methods of weight loss have been exhausted.

Ultimately, gastric lap-band insurance coverage is determined on a person-to-person basis (even when your insurance claims it will cover bariatric surgery).

Gastric Lap-Band> Insurance Coverage: Psychology Evaluation

Most insurance companies require an evaluation to establish your psychological condition is stable. Your bariatric surgeon may have a psychologist in his/her office to do the evaluation or may provide you a referral.

Gastric Lap-Band Insurance: What to Do If You Get Denied

A squeaky wheel gets oiled...

...start appealing!

You can write a letter of appeal yourself or you can get help from an attorney. I've had patients tell me they get a faster response with an attorney involved:

"I was approved within a week of them submitting the appeal. Somehow that attorney letter means a lot more than a single personal letter to the insurance company."

Read much more on Gastric Lap-Band Insurance Appeal

More About Gastric Band Surgery

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