Understanding Lap-Band Insurances

Many health insurers in Los Angeles now provide coverage for the Lap Band surgery procedure and it is considered an approved procedure as a treatment for morbid obesity. It is important to understand how your provider's policy works, as insurance carriers have various types of plans, and also differ from each other. Many insurers base their coverage of Lap Band surgery on criteria set by the National Institutes of Health (NIH), and some states have even passed laws that require weight loss surgery be covered if these criteria are met. The criteria are that you:

- Have been morbidly obese for 5 years or more
- Are at high risk for suffering from other medical conditions associated with severe obesity
- Have been diagnosed with severe obesity, and have a body mass index over 40. You can also have a body mass index of 35 or more, if it is combined with conditions such as diabetes, hypertension, heart disease, sleep apnea or degenerative arthritis.
- Have tried and failed to lose weight without surgery over several years (diet, exercise, weigh loss plans)
- Are highly psychologically motivated and ready for the procedure, and are a low risk for surgical complications

If you find that these criteria are met, then it is best to consult with a qualified and skilled Lap Band physician who can help to establish the necessity of the procedure. Your doctor will work with you to provide documentation for the insurance company that shows proof that you participated in weight loss programs, visited the doctor for exams, and were given weight loss advice. Once the need is established your insurance company will provide a "certificate of coverage" for your plan.

Insurance Company Requirements

Insurance companies will usually require a referral from your doctor in order to issue a certificate of coverage and a few basic items that should be submitted are:

1. A letter written by your primary care physician stating that there is a medical necessity for weight loss. This referral letter should include as many reasons as possible for the need, such as your Body Mass Index (over 35 or 40), your 5 year history of obesity, unsuccessful attempts to lose weight non-surgically, and other medical conditions or complications you may or could have that result from morbid obesity.

2. Medical records and documentation of any and all efforts and treatments related to weight loss attempts. This includes medical records of all doctors visits and treatment related to weight loss, receipts and documentation of other health care professionals for weight loss attempts, receipts from programs such as Jenny Craig or Weight watchers, exercise machines, gym memberships, diet and nutrition books on weight loss, herbs and medications, and anything else that you have done over the last few years.