One of the first questions which you need to ask yourself when it comes to lap band financing is whether or not your health insurance plan will cover any of your surgical and associated costs.
It is often thought that health insurance companies are loathe to cover treatment associated with obesity, including the cost of bariatric surgery. However, things are thankfully changing these days and many insurers do now provide coverage for the cost of gastric bypass and other forms of weight loss surgery, including lap band surgery.
Your starting point therefore must be to read carefully through your health insurance plan looking at both what is covered and what is not covered. You will also need to look carefully at the language used paying particular attention to sections covering the treatment of obesity and surgery for weight control. This can be a difficult exercise as in most cases where cover is provided there will be limitations placed on that cover and payment will only be made for those elements of the procedure which are expressly covered or not specifically excluded.
In some cases you will find that insurers will only meet the cost of lap band surgery when it is deemed to be a medical necessity and this can often open the door to a claim for obese patients whose BMI and general medical condition means that they fall within the national guidelines which currently exist for the treatment of morbid obesity.
In addition, where only partial cover is provided for lap banding, it may be possible to effectively extend this cover if your medical condition is such that additional abdominal surgery which is covered can be carried out at the same time. In this instance you may effectively be able to cover the cost of such things as the anesthetist’s fees and other hospital costs for your abdominal surgery and thereby reduce the effective cost of your lap banding.
Finally, pay especial attention to any requirement for pre-approval of surgery. In some cases insurance companies will ask for a letter of medical necessity from your doctor or surgeon, together with details of previous weight loss attempts and you should not proceed until these have been accepted and a letter of approval for your surgery has been issued. You should also not lose heart if your initial request is denied as you will have the right to appeal your insurer’s decision by addressing the specific concerns which led to your request being denied. You surgeon will be able to help you with any appeal and you will be surprised how often an initial denial is reversed on appeal.
A letter of medical necessity and supporting documentation should normally detail your weight, which should show you to have a BMI of greater than 40 or more than 35 with accompanying co-morbid conditions such as hypertension, type 2 diabetes or sleep apnea. It should also show that you have been overweight for some considerable time (normally at least five years) and that you have made a number of serious attempts to lose weight under medical supervision which have failed. The secret here is to provide as much relevant information as you can including details of any commercial weight loss programs or diets you have followed with as complete a medical record of your weight loss efforts as is possible.
This can be a complex area and, if you are in any doubt you should seek professional advice, perhaps from your doctor, or should contact your insurance company for advice. If you do contact your insurer however you should do so in writing and not by phone to avoid any possible misunderstandings when it comes time to make a claim for costs against your plan.
If you are not lucky enough to have health insurance for lap band surgery which will cover all of your costs, or indeed have no lap band insurance coverage, then you will need to look for additional funds to meet the full cost required for your lap band financing and here there are three main choices open to you.
The first is simply to meet the costs of surgery from your own resources if you are able to, perhaps by dipping into your savings or realizing some of your investments, such as stocks. It may also be possible to make use here of some 401K funding.
The second is to look at some for of credit to finance your operation such as credit cards or to take out a loan from a bank or other financial institution.
The third is to talk to the hospital or surgical center about a payment plan. In many cases the facility will be prepared to either offer you a payment plan themselves or to recommend a scheme such as the INAMED Health Lap-Band Patient Finance Program.
One important factor which should be taken into account is the availability of tax relief for out-of-pocket medical expenses. IRS Publication 502 allows you to deduct out-of-pocket medical expenses (including such things as hospital charges, doctor’s fees, prescription drug costs and fees for participating in weight loss programs for obesity) in certain circumstances and this can result in an effective discount of several thousand dollars for some lap band surgery patients.
Although the cost of lap band surgery can vary widely from about $12,000 to $30,000 depending on where your surgery is performed, the days of having to meet this cost in full from your own resources are thankfully largely behind us and morbid obesity is now a recognized disease for which lap band surgery is an approved procedure. Indeed, in some states the law now requires that insurance companies provide cover for weight loss surgery for patients who meet the criteria for morbid obesity treatment laid down by the National Institutes of Health (NIH).