Insurance Standards for Lap Band Surgery
Posted by Lori on February 17, 2008
Ahhh, now here’s a useful little guideline I found from the Centennial Center For The Treatmen of Obesity in Nashville, Tennessee that covers the standards of several dozen insurance companies around the nation - with a focus on (but not limited to) Blue Cross/Blue Shield. This will give you a good idea of what criteria insurance companies that cover lap band procedures are looking for.
For instance, here is what Blue Cross/Blue Shield Federal Employees program requires:
BlueCross BlueShield Federal Employees Program (1/07)
BMI of 40 or greater OR:BMI of 35 or more with co-morbidities
Documentation of failed conservative treatment
Letter of support from primary care physician
18 years of age
Gastric bypass and Lap-band procedures are covered
Here is the short definition of co-morbid conditions (lovely language, eh?) from the Blue Cross/Blue Shield of Arkansas:
BMI of 36 – 39 with a high-risk co-morbid condition such as uncontrolled diabetes mellitus, uncontrolled obstructive sleep apnea, uncontrolled hypertension or uncontrolled hyperlipidemia
For the medical terminology-impaired link-a-phobics amongst us, that translates to diabetes, big, ugly moose snoring because your breathing passage is obstructed while sleeping, high blood pressure and apparently (though I may have this wrong), high cholesterol. This is more or less the standard for the insurance companies that do cover lap band surgeries when your BMI is 35 or so.
If you haven’t calculated your BMI yet, you can do so here. They also provide you with a very conservative estimate of what you can reasonably expect to weigh as a result of your lap band. Remember, it’s a conservative estimate and you can impact the final number by paying close attention to your diet and by finally getting out and exercising a little - which I know you’re itchin’ to do.
The above is just one company. They have the standards for several other insurance companies and Blue Cross/Blue Shield for several states. If you have insurance but you haven’t been to a surgeon yet, this is a good place to find out if you stand a chance of getting your insurance to cover it.
