Why is the Lap-Band surgery not covered on my insurance?

Answer 1

MOST insurance companies don't cover it, because it's voluntary. Obesity is self-inflicted. People CAN diet and excercise to lose weight - it's safer, fewer side effects, and much cheaper.

There are very, very, very few instances of "true" metabolic issues. IF you have that, you can appeal the decision.

I used to work with a woman who told me she was "big boned" and that's why she was so heavy (almost 300lbs). However, when I compared my homemade lunch to hers, hers was about 3X as much food as mine. Her daily caloric intake was probably around 3000 calories. Mine is usually around 1500. When I'm nursing a baby, it's closer to 2000, and I can STILL lose weight at that. I don't have a weight problem. She does.

It's EASIER to ask for lap band surgery than it is to limit your caloric intake, and park at the far end of the parking lot and walk to the store, and stop taking elevators and use stairs instead. But the sad truth is, if you don't make a LIFESTYLE change, 10 years after the lap band surgery you're most likely to be obese again.

Answer 2

You must first determine why the insurance is not covering this. Is it being denied as not medically necessary or is it a specific limitation on your plan. If you have a certificate of coverage (plan book that details your benefits), look in the limitations and exclusions section. Many plan will list obesity in the limitations and exclusions. If this is the case, there is not much you can do since they dont cover any form of obesity. If the insurance company is denying it as not medically necessary there may be many reasons why and if you call them they should be able to tell you why. If obesity is covered you will have to meet the criteria of being considered morbidly obese which is 100 lbs over your ideal weight. If you are 100 lbs overweight other criteria must be met such as alternatives that have been tried prior to this surgery such as other diet programs and you also must have conseling prior to the surgery. I have been working in health insurance for over 10 years and have seen type of procedure go both ways. Also, find out if your plan is self funded. If it is a self funded plan your employer has the final say and they have the ability to make an "exception" to allow the surgery. But first start with your insurance company and find out why it is not covered. If your provider sent in a preauthorization you should get a letter in the mail explaining why it is not covered. Also, remember you can always appeal their decison by submitting additional medical records. It helps if you have an underlying medical condition due to your weight such as diabetes. Good Luck!

Answer 3

I don't know of any insurance that covers it on a regular basis. Most of the insurance companies claim it falls under "elective" or "cosmetic" surgery - and no insurance covers those. If plans started covering it without a big fight and one heck of a lot of proof that it would save the patient's life, then you'd have every person who is too lazy to diet and exercise to lose those pesky 20lbs wanting the quick fix. The other reality is, according to people that I know who have had the surgery (and they wouldn't wish it on their worst enemies) is that there is a lot of care involved - you need to have several months of pre-operative therapy sessions with a psychiatrist, pre-op testing which includes bloodwork, and several physical exams - all of which adds up to a LOT of money.

However, as to what pertains to YOUR insurance - call member services for your plan - the number is on the back of your card, and ask THEM why it's not covered.

Answer 4

If you're looking for a private policy, you'd better start doing research on plans available in your state... Not all insurance companies offer coverage in all states. Not all plans offer the same benefits. Most insurance companies cover lap band in one way or another, its finding a plan that you qualify for that is difficult. I don't really have additional info without knowing what state you live in.

Answer 5

Most insurance plans don't cover services that are not considered "medically necessary". This includes services like elective plastic surgery, teeth whitening, vitamins, etc. Some plans even exclude birth control pills because they aren't medically necessary. My guess is, this is why the surgery isn't covered by your insurance plan, but I'd double check with them to be sure.

Answer 6

Well, if you have self funded, group health insurance through your job, you should ask your employer why its not covered. If you have private insurance or a Traditionally funded plan through your job its not part of the package you chose. Some plans do cover the procedure. The ultimate answer is this... Whatever benefit package you have, doesn't include this procedure. Good luck.

Answer 7

Generally, bariatric surgeries are something that must be added separately to the policy by the group negotiating the benefit plan.

Your employer may have chosen not to add coverage for bariatric surgeries on your policy for any number of reasons (to control premium costs, etc.).

Answer 8

Because you can lose weight with diet and excercise. The Lap-Band is considered elective surgery.

Answer 9

Probably because your insurer considers this type of surgery elective or possibly experimental.

Answer 10

Speak to your insurance company