In the United States today, obesity is an epidemic affecting over 70 million adults. This number equates to two out of every three adults, making it one of the most common conditions with serious health consequences in this country.
Because there is such a high risk factor for health complications due to obesity, and losing weight is not an easy task, physicians are prescribing bariatric surgical procedures to help people in their difficult fight for weight loss success. For people who are obese or morbidly obese, with a body mass index over 30, gastric banding is a surgical treatment option if more conventional methods like dieting and exercise have been ineffective.
If your health care provider has mentioned lap band surgery as an option for weight reduction, you should have all the facts about what the surgery entails, whether your Medicare insurance covers the cost, and if you are eligible for Medicare coverage of this type of procedure.
What is Lap Band Surgery?
Laparoscopic adjustable gastric banding (LABG), is the name of a surgical procedure used to close off a portion of the stomach so the recipient can lose weight easier. This procedure is also known by its more popular name of lap band surgery. “Lap Band” is actually the name of a well-known device brand, but it has become a common name for the gastric banding procedure.
In gastric banding procedures, a surgeon places an adjustable band around the patient’s upper stomach portion. The doctor adjusts the band’s tightness by adding or removing saline solution to the band through a port that is under the skin of the abdomen.
The purpose of the band is to make the stomach smaller in size and capacity. This results in the restriction of the amount of food consumed as well as the amount of time that it takes for the food to pass from the stomach to the intestines. This creates a sensation of being full and helps the patient limit food intake resulting in weight loss.
Does Medicare Help Pay for Lap Band Surgery?
Some types of bariatric surgery like laparoscopic adjustable gastric banding or gastric bypass procedures are included in your Medicare coverage if you are eligible. In order for Medicare to allow coverage, the procedure must be done in a Medicare-approved center for bariatric procedures and you must also meet the following requirements:
• You must have a body mass index of at least 35 and you must also have another related health condition such as sleep apnea or diabetes.
• Your medical records must provide proof that you have been obese for more than five years prior to the procedure.
• Your medical records must also prove that you have attempted, and failed, to lose weight through the assistance of at least one other weight-loss program.
• You must pass a psychological evaluation.
• You have been tested for other treatable conditions that may affect your weight, and they have been ruled out. Such conditions may include thyroid, adrenal, or pituitary abnormalities.
If you have Original Medicare and meet the criteria for coverage, Medicare insurance will cover 80 percent of the cost of your lap band surgery. You are responsible for the remaining 20 percent as well as your deductibles for Original Medicare Parts A and B. If you are enrolled in a Medicare Advantage plan, you will have at least the same coverage as Original Medicare, but many plans will offer additional benefits.
Cost Benefits of Lap Band Surgery with Medicare Coverage
Well over 100,000 people undergo some form of bariatric surgery every year in the U.S., and laparoscopic gastric banding accounts for more than 35 percent of these procedures.
It is difficult to calculate an exact cost for lap band surgery because there are so many variables involved. The final cost depends on the type of procedure, where you live, who does the surgery, and what care you need before and after the procedure. Without insurance, you may have to pay between $8,800.00 and $22,500.00. Studies show that morbidly obese patients who undergo a bariatric procedure have a decrease of 29 percent in their health care costs over the following five year period after their surgery.