Do you qualify for the lap-band surgery?

checklist-2What are the requirements for lap-band surgery? Do you know whether you qualify to get the gastric band? Depending on whether you choose to pay for your surgery with health insurance or out of your pocket you may have to meet different requirements. The requirements for adjustable gastric band can also differ from clinic to clinic, so depending on the weight loss facility you choose there may be additional steps you’ll need to take before getting your lap-band. Essentially there are three categories of requirements that you need to meet to qualify for the lap-band:

  • Medical Requirements
  • Insurance Requirements
  • Clinic Specific Requirements

 

Medical Requirements

Basic medical requirements for lap-band surgery state that you need to be 18 years or older and your BMI has to over 30. Medical clearance also requires that lap-band candidates have no medical conditions that can make them poor surgical candidates or increase the risk of poor results (e.g., inflammatory or cardiopulmonary diseases, GI conditions, symptoms or family history of autoimmune disease, cirrhosis). People who are unwilling or unable to comply with the required dietary restrictions, who have alcohol or drug addictions, or who are currently or may be pregnant would also not be appropriate candidates for lap-band surgery. During your visit at the gastric band clinic, the bariatric team will help you determine if you qualify for the gastric band procedure. Your lap-band surgeon will determine if there is anything in your medical history that could potentially stand in your way of getting the most out of your band.

The bariatric dietitian will also evaluate your diet and establish whether you are prone to making food choices which could potentially negatively impact your weight loss after bariatric surgery. In the case of dietary contraindications, lap-band would not be an effective tool for patients with eating disorders or who are prone to eating mushy high calorie foods. Patients with these issues would not be automatically disqualified from getting the gastric band, but would have to work with the bariatric dietitian to address their bad eating habits prior to the surgery.

Insurance Requirements    

Depending on your health insurance policy, your provider may require you to meet multiple requirements before getting your gastric band surgery. Among basic requirements is the weight requirement. If you decide to pay for your weight loss surgery with health insurance your BMI has to be a minimum 35 and you need to have at least two co-morbid conditions associated with your weight. Co-morbid conditions mean life threatening health diagnoses related to your extra weight. The most common conditions recognized by insurance as weight related and life threatening are:

  • type 2 diabetes,
  • hypertension,
  • sleep apnea,
  • hyperlipidemia

In order for health insurance companies to recognize these conditions as suitable, a patient needs to be receiving treatment (medication) at the time of filling the coverage claim. If your BMI is 40 or more, no additional co-morbid conditions are necessary for the insurance to recognize the lap-band as necessary treatment option.

In addition to the weight minimum, insurance companies will also require potential lap-band candidates to undergo a three to six-month supervised dietary program and a psychological evaluation. In order to qualify for the gastric band you will most likely need to see you bariatric dietitian for three to six consecutive months for dietary consultations. Depending on your progress with the dietitian, at the end of the diet period you should receive a report stating you are willing and capable to make the necessary lifestyle changes following the surgery. In respect to your psychological evaluation, most insurance policies require you to meet with the psychologist. The purpose of the psychological evaluation is for the insurance company to learn whether you have a full understanding of the banding procedure and how the band will affect your life post-surgery. Both nutritional and psychological evaluations will be submitted to your insurance provider once you are ready for your lap-band surgery. Receiving letters of approval from your surgeon, dietitian, and a psychologist will be a sign to your insurance provider that you meet the requirements for the lap-band surgery and that you are the right candidate to undergo weight loss surgery.

Clinic Specific Requirements

In addition to requirements posed by your insurance and bariatric surgeon, each clinic has its own set of requirements and a way of screening patients awaiting weight loss surgery. Oftentimes, the requirements poised by the clinics don’t differ much from those given by insurance and a physician. Nevertheless, occasionally banding clinics require their patients to attend a seminar or meet with the dietitian more often than specified by the insurance. In some cases, patients can’t qualify for gastric banding unless they undergo counseling or participate in more extensive preparation for lifestyle changes following lap-band surgery.