Does Insurance Cover Lap Band Surgery


If you are more than 100 pounds overweight you may wonder, "Does insurance cover lap band surgery?" Lap band surgery is an alternative to stomach stapling or cutting that allows you to shrink the size of your stomach so you can eat less and feel full more quickly. It can allow you to lose hundreds of pounds safely and with relative ease and make it much easier for you to change your lifestyle and eat less, but it can also be expensive.

Lap Band Surgery Explained

Lap band surgery is a type of weight loss surgery that uses a special surgical "band" to make your stomach smaller. While there are many different types of surgery that are commonly called "lap band" surgery, the actual term "Lap Band" is a trademarked brand name that belongs to Allergan Inc. However, when you refer to lap band surgery, you may be referring to any procedure that uses a similar technique.

The Technique

During lap band surgery, your doctor uses a band to separate the upper part of your stomach from the lower part of your stomach. Usually, the band is connected to a tube that creates an access port. The doctor then uses the access port to gradually tighten the belt over a period of several weeks.

The band makes the stomach smaller, so you feel full with much less food. In fact, your stomach simply cannot accommodate more than a small amount of food at a time, so you will be essentially unable to overeat without becoming ill. As a result, you will begin to lose weight and feel less incentive to eat large amounts of food.

Does Insurance Cover Lap Band Surgery?

The answer to the question of does insurance cover lap band surgery varies depending on your situation and your insurance carrier. Many carriers do cover the procedure, as long as it is deemed medically necessary. The reason many insurance carriers cover the procedure is due to the dangers of obesity on your health. If you are obese, you are at a greater risk for a number of expensive health problems, including diabetes and heart attack. As such, insurance companies may wish to provide you with coverage for lap band surgery if you need the surgery to save your life or stop you from developing serious diseases.

However, the surgery is not covered if it is considered cosmetic surgery. In other words, if you don't need the surgery but you want it just because you want to look thinner, then the surgery will not be covered. Even in cases where it is medically necessary, there are still some carriers who will not cover lap band surgery or who will only cover partial costs of this or any other bariatric procedure.

Determining Coverage

To determine coverage, review your insurance policy. Look for information on whether your coverage includes or excludes weight or obesity control procedures or whether your coverage excludes or limits bariatric procedures. Contact your insurance company if you have any doubts, or ask the doctor who is recommending or performing your lap band surgery to contact the insurance company on your behalf to help determine coverage.

Surgery Without Coverage

If you do not have coverage, consider speaking with your doctor about a payment plan or other financing options. You can also check with your employer to see if your flexible spending account (FSA) will allow you to pay for the procedure with pre-tax dollars.

While the surgery may be expensive without insurance coverage, you may be able to work out a way to pay for the procedure in order to improve your long term health.

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Does Insurance Cover Lap Band Surgery