What health insurance companies cover the lap band surgery?

Via: Google Images

Obesity is an ever-growing epidemic in the United States. Once upon a time, obesity was much less of a problem for Americans. In 1990, only 11.6% of the nation’s population had a BMI of 30 or higher—categorizing them as obese. Fast-forward to today and that figure is now 29.6%. We could go into detail about how we got to where we are as a nation and the oodles of ways people can spend time shedding pounds, but sometimes diet and exercise aren’t enough. In those cases, more extreme measures are sometimes necessary to save someone’s life or jumpstart their road to successful weight loss.

The Lap-band procedure was approved in 2007 for the surgical treatment of obesity to help people eat less and shed pounds. On average, it costs around $14,500. This procedure doesn’t fit the bill for all weight loss needs. No insurance company will cover the costs of the surgery if the patient is not a proven candidate for it. What does that mean exactly? A qualifying candidate must either have a body mass index of at least 40 or a BMI between 30 and 40 with one or more qualifying conditions related to their obesity such as high blood pressure or sleep apnea. It’s also a general requirement that other, less invasive attempts to lose weight be attempted without success prior to resorting to Lap-band surgery.

More than 750,000 people have undergone this procedure to enforce control over their eating habits and lose weight as a result. The vast majority of all health insurance companies are now covering at least some of the cost of Lap-band surgeries. While some insurance companies cover the procedure regardless of overall health, many will only do so if Lap-band surgery is deemed medically necessary for the patient.

Now that the Affordable Care Act is in effect, things are a bit different. Depending on the state where you reside, you may be able to obtain health insurance that covers the procedure more easily. The ACA orders that individual, family and small group insurance plans in the following states include bariatric surgery coverage: Arizona, California, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Rhode Island, South Dakota, Vermont, West Virginia, and Wyoming.

Assuming you have one of these companies that will cover the costs associated with Lap-band surgery, you then have to figure out just how much of it they’ll cover. You may be responsible for a portion of the costs incurred. In 2012, 9 out of 10 Lap-band surgeries performed were paid for at least part if not in totality by insurance companies.


Cite this page: Danielle Bosley, "What health insurance companies cover the lap band surgery?," in PsychologyDictionary.org, April 5, 2016, https://psychologydictionary.org/what-health-insurance-companies-cover-the-lap-band-surgery/ (accessed August 7, 2022).