There's no good answer to the question everyone wants to know...
...will my insurance cover my gastric banding surgery...
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:
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.
A letter of medical necessity may need to include (but might not be limited to) the following:
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:
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.
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...
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