| When you plan to have lap band surgery, one | | | | Tufts Health Plan |
| important factor you have to consider is how you | | | | One will require a Letter of Medical Necessity and a |
| are going to pay for the weight loss surgery. | | | | history of your weight loss attempts in order to be |
| Insurance coverage for Lap Band surgery is normally | | | | granted coverage for the surgery. The following |
| granted or denied on an individual basis. For this | | | | information is usually included in the Letter of Medical |
| reason, you have to be aware of your particular | | | | Necessity: |
| insurance provider's policies. | | | | A weight that should be 100 pounds or more above |
| When reviewing your insurance policy, you should | | | | your ideal weight. |
| look at the area in your policy that states: "What Is | | | | List of medical problems associated with obesity, |
| Covered" or "Covered Expenses." These are the | | | | such as type 2 diabetes, sleep apnea, hypertension, |
| healthcare benefits that the insurance provider will | | | | etc. |
| cover. In this section, search for a statement that | | | | Number of years that you have been overweight (at |
| says the provider excludes coverage for "weight | | | | least five or more) |
| control, for the treatment of obesity, for the surgery | | | | A detailed list of all your weight-loss attempts |
| for weight control, or for the complications of the | | | | Source: |
| surgery for weight control." Some providers will state | | | | Most insurance companies will rely on the National |
| they exclude all forms of weight loss surgery while | | | | Institute of Health (NIH) guidelines to determine if a |
| others will state certain areas that they will provide | | | | client should have weight loss surgery coverage. The |
| coverage. For instance, they may state they will | | | | NIH guidelines state that weight loss surgery may be |
| cover "when deemed medically necessary." The | | | | an option for patients who "1) have failed with other |
| policy will likely state certain conditions that must be | | | | weight loss treatments and 2) have a BMI of 40 or |
| met. You need to find out about their exact | | | | greater, or have a BMI of at least 35 and |
| conditions. | | | | co-morbidities." |
| You should also check to see if you can get partial | | | | If your insurance plan has an exclusion listed for |
| coverage. There may be a way to have some areas | | | | weight loss surgery, you may still be able to get |
| associated with the lap band process covered such | | | | approval. You will have to appeal the exclusion and |
| as hospital fees. | | | | get a letter from your physician stating that lap band |
| The following is a list of insurance providers that | | | | surgery is the best method of treatment for your |
| either partially or completely cover Lap Band surgery: | | | | life-threatening condition. Such health conditions can |
| Blue Cross (some states) | | | | include: diabetes, high blood pressure, and heart |
| United Healthcare | | | | disease. You may possibly get approval for weight |
| Oxford Health Plan | | | | loss surgery as a treatment for one of these health |
| Medicaid | | | | conditions. |
| American Family Insurance | | | | Lap band surgery is an expensive weight loss |
| Humana | | | | procedure. If obesity is a serious health risk, it is |
| First Health | | | | important to check with your insurance provider to |
| One Health | | | | see if you are covered. |