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When it come to weight loss surgery, most states require insurance companies to cover the cost of a weight loss surgery, including the Lap Band procedure, as long as the patient passes the minimum requirements set forth by the National Institutes of Health. It is important that in the event you are contemplating a Lap-Band procedure that you check to see whether or not your insurance company will cover the procedure as well as whether the surgeon will accept coverage from your insurance company. Because of the many variables covering various insurance policies it is important for you to check with your surgeon, insurance company and in some cases the local laws.
Another important part is that if you are planning on undergoing a Lap-Band procedure and paying for it with your insurance coverage then you need to start speaking with the insurance company as soon as possible because the approval process can take a while to clear. In many cases, the patient may contact the insurance provider and get told that weight loss surgery is not covered by their insurance company when in fact it is. This will most likely happen due to misinformation amongst the ranks in the insurance company as well as the insurance company’s guidelines in an attempt to deny you the coverage. If you are told that it is not covered then you may want to talk to your family physician who often deals with the insurance company. He or she would be able to give a letter of recommendation for the procedure while at the same time be able to talk to someone higher in the company than you would.
In some cases still, you may be in a state that requires the insurance company to cover the weight loss surgery and you may also have passed all the necessary requirements for the approval and are still denied. If this is the case then you can even contact the Obesity Law and Advocacy Center who specializes in letting the insurance company know there legal requirements in covering the surgery.
Having your family doctor write a letter of medical necessity to your insurance provider will help the long approval process go smoother. Make sure that you have well documented the fact that you have been obese for at least 5 years prior to the surgery and in the last 6 months you have been in a structured weight loss program. |
