Insurance Coverage

Obesity is predicted to surpass smoking as the leading cause of preventable death in the United States. For this reason, insurance companies are expanding their coverage of bariatric surgery, specifically LAGB surgery using the LAP-BAND^® System. However in many cases, stipulations apply.

For example, as of February 21, 2006, the Centers for Medicare and Medicaid Services (CMS) will only cover LAGB that is performed at a BSCOE. Their rationale is that there is adequate evidence to conclude that LAGB is reasonable and necessary for Medicare beneficiaries who are under 65 years of age, have a body-mass index (BMI) >35, have at least 1 comorbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity.

As of 2007, Blue Cross/Blue Shield will cover LAGB surgery when it is performed in appropriately selected patients, by experienced and trained bariatric surgeons, and in institutions providing comprehensive long-term monitoring and postsurgical follow-up.

Since June 2006, Allergan, Inc has gained LAP-BAND^® System coverage in policies representing 187 million commercial lives in the United States. Adding Medicare lives to this total, the LAP-BAND^® System is currently covered for an estimated 230 million lives. Allergan, Inc has dedicated a field team to educate customers about obtaining reimbursement for LAP-BAND^® System surgery. Available resources include a billing guide, information on new CPT codes, and advice about preauthorizations and appeals. Allergan, Inc also provides documentation of costs associated with LAP-BAND^® System procedures in order to assist bariatric surgeons in renegotiating their contracted rates.