How Much Does Lap Band Surgery Cost?
The average cost of lap band surgery is $9,568, according recent reviews on RealSelf. However, the price can range widely, from just $4,750 with insurance to as much as $20,000 without insurance.
Read on to find out when insurance covers lap band surgery and why you might pay more or less for this popular weight loss procedure.
Is lap band surgery covered by insurance?
In recent years, more and more insurance providers have begun to cover weight loss surgery, including laparoscopic gastric banding.
You may be surprised to learn that Medicare also pays for lap band surgery, as long as the patient has a BMI (body mass index) of 35 or above. Usually, the patient will have to complete a medically supervised weight loss program before Medicare will cover the cost of lap band surgery. In some states, bariatric surgery may be covered by Medicaid.
Your insurance company will have to determine that your surgical procedure is medically necessary before they can deem it worthy of coverage. Do do this, your surgeon will have to provide a letter documenting why you need a lap band system. This letter should detail your obesity-related health conditions (like sleep apnea, diabetes, high blood pressure, and heart disease), a thorough history of past attempts to lose weight through other means, and a list of current medications that you take.
Bariatric surgeons and their office staff have extensive experience in working with insurance companies to obtain coverage, so they should have the process down, but it's always a good idea to check with your insurance carrier first, to make sure you're providing all of the right documentation.
If your coverage request is denied, you can always initiate an appeal. This needs to be done immediately.
Even if your request for insurance coverage is approved at a level that covers most of the cost, you can still expect to have some out-of-pocket expenses, depending on your copay and deductible. You may also have related medical expenses (for things like nutritional coaching).
Ask your surgeon if they can provide an estimate of related fees, and discuss payment plans or financing options.
What affects the cost of lap band surgery?
The cost of lap band surgery can fluctuate, due to factors like:
1. Your provider’s credentials and level of expertise
Laparoscopic gastric banding is an outpatient procedure that boasts minimal complications, in comparison to other forms of weight loss surgery (like gastric bypass or gastric sleeve surgery), but it’s still a complex surgical procedure performed under general anesthesia.
More experienced surgeons will have a higher surgeon's fee, but ensuring your bariatric surgeon is well-qualified will go a long way towards reducing risks and side effects.
Look for a physician who is a member of the American Society of Metabolic and Bariatric Surgeons. This organization mandates that their members be board certified and have performed a minimum of 25 bariatric surgeries within the past two years.
When meeting prospective surgeons for consultations, ask them how often they perform the lap band procedure, their complication rate, and what kind of follow-up care they offer.
As with other weight loss surgeries, the lap band system is only effective if the patient also commits to lifestyle changes. Access to resources like a nutritionist or dietician, support groups, therapy, and physical therapy can go a long way towards supporting your weight loss goals.
2. Their practice location
You can expect lap band surgery to be more expensive in major metropolitan areas, which have higher rents and costs of living, than smaller cities.
Your surgery could end up being on the pricey side if you’re in an area with only a few bariatric surgeons who don't have to compete for patients, while areas where obesity and weight loss surgery are prevalent (including states like Texas, Oklahoma, and Nebraska) have lower average costs.
Because of the varying cost of lap band surgery, many patients go the medical tourism route and travel abroad for a smaller bill.
Providers in countries like Mexico and Costa Rica can offer significantly reduced prices on a lap band procedure—in some cases, you could end up paying just one-third of the cost you’d pay to get the procedure stateside. Just keep in mind that you'll still need to carefully research your provider's credentials and make sure you have a plan for follow-up care in or near your hometown.
Related: 6 Key Things to Do If You're Traveling Outside the U.S. for Surgery
3. The venue of your surgical procedure
As previously mentioned, lap band surgery is less complex than most types of bariatric surgery. That means that a gastric banding procedure can be performed in either a hospital or at your doctor's private surgery center. If you're having your procedure in the U.S., ask if your surgery will be performed at surgical center that has been certified for safety by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF).
Hospital fees and related medical expenses can cost more than what you'd pay in a private surgery center, but it may be worth the extra expense to have your surgery in a hospital if you're a high-risk patient, due to issues like heart disease or diabetes. In the unlikely event of a complication during surgery, emergency help will be close at hand.
4. Who administers your anesthesia
A lap band procedure requires general anesthesia, which can be administered by either an anesthesiologist (MD) or a nurse anesthetist (CRNA). Some surgeons prefer the expertise of an MD, but if you're concerned about keeping fees low, ask whether your anesthesia can be administered by a CRNA.
Along with the fee for your anesthesia provider (who will be present throughout your procedure), you'll have to pay for the related supplies and anyone else who's assisting with your anesthesia.
5. The cost of adjustments and follow-up care
When you’re budgeting for lap band surgery, ask your provider about the ongoing cost of having the device, including regular follow-ups and band adjustments.
Most lap band patients need band adjustment 6–10 times in the first year or two, according to doctors on RealSelf.
6. Whether or not it’s covered by health insurance
Many insurance providers cover surgical procedures that address obesity, including gastric banding, as well as operations to remove hanging skin that can remain after extreme weight loss (such as a panniculectomies and body lifts).
Read more about insurance coverage for bariatric surgery below.