Financing the Cost of Lap Band Surgery in Arizona

Weight loss can change your life and significantly improve your health. You may also find that dramatic weight loss can greatly reduce weight-related costs, which on average can be more than $15,000 a year! What better investment could you make in yourself and your future?

Today many health plans cover the LAP-BAND® procedure and most, if not all of the costs will be paid for. Each health plan will have certain criteria that need to be met before you can actually have the surgery. Talk to your surgeon about health plans in your area that cover LAP-BAND surgery. In some cases your insurance may not cover the LAP-BAND procedure. This can be in the form of a “Denial” to what is called a Prior Authorization Request.

Following denial or when insurance coverage for the cost of lap band surgery in Arizona is not available, there are several alternatives that can be considered as viable payment options. These include lump sum payment and affordable patient financing.

Here are a few places we have worked with that finance our patients directly:

• Reliance 1-800-322-6377

• Care Credit  1-866-893-7864  

• National City 1-888-242-9039×2031

• Capital One 1-877-559-5050

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 of morbid obesity.

Submission Requirements

A Letter of Medical Necessity and weight-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:

• Patient’s weight (which should be 100 pounds or more above ideal weight or a BMI more than 40 or at least 35 with associated medical problems to qualify)

• List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.

• Number of years patient has been overweight (which should be at least five or more)

• Number and types of failed weight-loss programs attempted in the past

If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the LAP-BAND or gastric bypass procedure. You should include any commercial diets or medical records of your weight-loss efforts.

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.

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 for the cost of lap band surgery in Arizona is another alternative you may consider. Please ask us about available patient financing programs during the patient seminar or your office visit.