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)
