PAYING FOR TREATMENT

While the LAP-BAND surgery program has a hefty price tag, some or all of the cost may be covered by your existing health insurance policy. You should be aware that some insurance companies are not yet paying for LAP-BAND surgery since it is still fairly new to the market. Others may pay for only part of the procedure. Each insurance company is unique in their requirements and the way they deal with LAP-BAND surgery and policies change frequently.

If you are interested in LAP-BAND and your physician feels you can benefit from the procedure, we will work with you and your insurance carrier to help you get any benefits that are available to you. If your insurance provider is unable to help you, we will help coordinate financing of the LAP-BAND through outside sources.

Insurance Verification
To determine if your insurance policy covers obesity (or "bariatric") surgery, refer to the information package that came with your policy. Typically, there are two sections that describe the extent and limits of coverage. The first is usually called "What Is Covered" or "Covered Expenses." These are the healthcare benefits for which the company will pay. The other section is "What Is Not Covered" or "When the Plan Does Not Pay Benefits." In this section the company tells the insured which treatments they must pay for themselves. You should refer to your insurance information to determine whether your policy covers surgical treatment of morbid obesity.

Some policies specifically exclude bariatric or weight control surgeries. Others may have certain parameters that determine which bariatric procedures they will cover and how much of the costs they will cover.

Submission Requirements
A Letter of Medical Necessity including a specific history of weight-loss attempts is usually required in order to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for the patient and usually includes the following information:

• Patient's weight (This should typically be 100 pounds or more above ideal weight – this means a BMI of more than 40 kg/m2 or more than 35 kg/m2 with at least one associated medical problem to qualify)
• List of medical problems associated with obesity, such as Type 2 diabetes, sleep apnea, hypertension, etc.
• Number of years patient has been overweight (which should be at least five or more)
• Number and types of failed weight-loss programs attempted in the past
  If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the LAP-BAND procedure. You should include any commercial diets or medical records of your weight-loss efforts.

Appeals and Patient Financing
If coverage has been denied after an initial request for prior authorization, you can appeal that denial by addressing the specific reasons why your request has been denied. Your surgeon’s office staff can be very helpful in this process, but you will need to be actively involved. When insurance reimbursement is not available, patient financing is another alternative you may consider. Please ask about available patient financing programs during the patient seminar or your office visit.

Financing now available through Capital One.