Medicare Requirements for Lap-Band Surgery

Though lap band surgery may be a medically necessary and life-saving procedure for many patients, it's also a very expensive procedure, ranging between $15,000 and $20,000 in the United States as of 2009. Therefore, Medicare, like most insurance companies, has strict criteria that the patient must adhere to before being approved for surgery.

BMI

• A patient is classified as being morbidly obese with a BMI of 40 or above. The patient must have been obese for at last five years or more.

Medical Conditions

• If the patient has a BMI between 35 and 40 then he must have at least one of the co-morbidities associated with obesity, such as diabetes, cardiovascular disease, hypertension or sleep apnea.

Previously Unsuccessful

• The patient must show documented evidence that her previous weight loss attempts have been unsuccessful through conventional diet and exercise. Records of supervised dieting are also required.

Pre-requisites

• Patients must attend a surgical consultation, undergo a psychological exam and attend pre-op classes. Patients must follow a special pre-op diet, low in calories, fat and carbohydrates and high in protein. This will reduce fat around the stomach and improve the outcome of surgery.

Commitment

• The patient must understand and accept the risks associated with surgery, and the need for life-long aftercare and follow-ups. The aftercare will involve a multidisciplinary approach, including nutritional, psychological and physiological care.

Facility

• The surgery can only be carried out by Medicare-approved surgeons in Medicare-approved facilities that have been certified by the American Society for Bariatric Surgery (to locate a facility near you, follow the link in resources)