By: Gloria Samuels

In the US, the cash pay cost of lap band surgery can be as low as $9999 in some areas of the country, and often range from $12,000 to $15,000 or more.

Is lap band surgery covered by my insurance?  Where do I start to find out if my insurance will cover weight loss surgery?  What are my out-of-pocket costs?  I don't have insurance and want to know what it will cost if I "cash pay" to see if it's really an option.  Is there financing available?  What are after-care costs?  These are a few of the frequently asked questions about the cost of lap band surgery.

Insurance

Bariatric surgery is often covered by insurance.  The majority of us in the US have some type of bariatric coverage.  But coverage and pre-requisites vary a great deal.  Typically in the US, in order to be considered for insurance eligibility, you must meet specific guidelines which for severe obesity defined as:

• Having a Body Mass Index (BMI) of 40 or greater or
• Having a BMI of 35 or greater with related medical conditions. Related medical conditions often include, but are not necessarily limited to: arthritis, diabetes, hypertension, liver and gallbladder disease, and cardiovascular disease

In addition, you may be required to meet  specific requirements of your insurance  carrier such as: 5 years of a documented history of obesity, 12 months medically supervised weight loss, out-of- pocket costs greater than $3K, or other requirements.

You can get more information by calling your employer's benefits department at work and/or calling your insurance carrier to get specific details about your plan, pre-requisites, out-of-pocket costs and specific exclusions.  When calling make sure to have your group number and membership identification number since all insurance plans have options within the plans to cover or not cover certain things. For example, some plans have a specific exclusion for bariatric surgery, which means regardless of your circumstances, that plan will not pay for any bariatric surgery.  This is important information to find out early.

Once you find a potential bariatric surgeon, the surgeon's office will typically work with you to help you understand what your insurance covers and does not cover; they can help you understand your pre-requisites and out-of-pocket expenses. 

The Obesity Action Coalition (OAC) has a free brochure entitled "Working with Your Insurance Provider: A Guide to Seeking Weight-loss Surgery.  To access the OAC brochure click here.  This is a very helpful resource that includes:

• Reviewing your policy
• Helpful Tips When Working with Your Insurance Provider
• The Pre-approval Process
• Appealing a Denial
• Other Options to Pay for Surgery
• Sample Letters to Insurance Provider
• Glossary of Terms

The manufacturer of the LAP-BAND® System,  Allergan has hotline for an initial eligibility review at 1-800-LAP-BAND; choose option 3.  In addition they have on-line resources at lapband.com.

The manufacturer of the REALIZE® Solution also has resources to help you understand your insurance eligibility at realize.com.

Cash Pay

In the US, the cash pay cost of lap band surgery can be as low as $9999 in some areas of the country, and often range from $12,000 to $15,000 or more.  Cash pay prices may or may not include after-care.  If you are considering cash pay, it is very important to understand what the cash pay price includes and does not include. 

After-Care

At bandedliving.com, we stress that the journey begins with surgery.  After-care is critically important to success with lap band surgery.  Expect to see your surgical practice frequently during the first year or more following your surgery for adjustments, advice, nutritional and exercise counseling, support and any issues that arise.  Office visits typically cost $100 - $150 or more.  One of the Lessons of Successful Lap Band Patients is: Stay Close to Your Surgeon and Their Practice.  Expect to see your surgical practice 6 -12 times or more during the first year.

It is important to understand what your insurance covers in terms of aftercare and what it does not cover.

If you travel for surgery, where will you have your after-care?  What costs will you incur?  If you have a complication, where will you go and what will it cost?

If you are cash pay, what is included?  For example some cash pay prices include all office visits and adjustments for a year or more; some don't include any.  It is very important to understand what is and is not included in the cash pay price.  What appears more economical at first may actually be more expensive when you factor in the costs of aftercare.

Financing Your Lap Band Surgery

There are a variety of financing options available.  Your surgeon and the lap band manufacturers can help you learn more about financing options.  Some options include: Care Credit, Chase Health Funding and BLIS.  In addition to offering financing, BLIS offers a unique product through BLIS surgeons to provide protection if an uncovered complication arises; BLIS protection works similar to a new car warranty.

Summary

When trying to understand the cost of lap band surgery, there is a lot more to consider than the cost of the procedure itself.  This article is intended to help get you started based on information currently available.  If you find new or updated information that you think our community should be aware of, please contact us at gloria.sandi@bandedliving.com . 

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