A: The FDA approved the BioEnterics® LAP-BAND® on June 5, 2001 (for details go to http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01087.html.
Insurance Verification
To determine if your insurance policy covers obesity (or "bariatric") surgery, refer to the insurance policy package that you have received after paying your first premium or provided through a plan offered by your employer.
Typically, there are two sections that describe the extent and limits of coverage. The first is usually called "What Is Covered" or "Covered Expenses." These are the healthcare benefits for which the company will pay. The other section is "What Is Not Covered" or "When the Plan Does Not Pay Benefits." In this section, look for any statement that the company excludes coverage for weight control, for the treatment of obesity, for the surgery for weight control, or for the complications of the surgery for weight control. Some policies will outright exclude bariatric surgeries. Others may have certain parameters around which bariatric procedures they cover and how much of the costs they cover. Look for statements such as, "Surgery for the treatment of obesity is covered when deemed medically necessary," or "Surgery for the treatment of obesity is (specifically) excluded except when medically necessary." If this surgery is a covered benefit when medically necessary, then it should be covered when patients meet national guidelines for care for morbid obesity.
We will provide you with the necessary paperwork so you can file your claim with your insurance company.
Appeals and Patient Financing
If coverage has been denied upon the initial prior authorization request, you can appeal by addressing the specific reasons why your request has been denied. Most if not all of our appeals are handled by the Inamed LAP-BAND® Hotline.
You can also contact a lawyer with expertise to help you with the appeal. More information about legal help can be found at The Obesity Law and Advocacy Web site at www.obesitylaw.com.
When insurance reimbursement is not available, patient financing is another alternative you may consider. Please ask us about available patient financing programs during the patient seminar or your office visit.
One final point:
It is important that you ask us all the questions you have about obesity surgery and the LAP-BAND® System.
LAP-BAND® is a registered trademark of Allergan, Inc.
Dixon J., Dixon A., O’Brien P. Light to Moderate Alcohol Consumption: Obesity and the Metabolic Syndrome. Am J Bariatric Medicine 2002; 17(4): 11-14