To determine if your insurance policy covers obesity (or “bariatric”) surgery, refer to the insurance policy package that you have received after paying your first premium or provided through a plan offered by your employer. If you do not have one, call the company and obtain a policy package as soon as possible. You may also call the customer service number (typically located on the back of your insurance card) ask if the Lap-Band (CPT code 43770) is a covered benefit under your plan. After determining that it is a covered benefit, we recommend that you ask about the necessary criteria that must be met in order to be approved or meet medical necessity.
Typically, there are two sections that describe the extent and limits of coverage. The first is usually called “What Is Covered” or “Covered Expenses.” These are the healthcare benefits for which the company will pay. The other section is “What Is Not Covered” or “When the Plan Does Not Pay Benefits.” In this section, look for any statement that the company excludes coverage for weight control, for the treatment of obesity, for the surgery for weight control, or for the complications of the surgery for weight control. Some policies will outright exclude bariatric surgeries.
Others may have certain parameters around which bariatric procedures they cover and how much of the costs they cover. Look for statements such as, “Surgery for the treatment of obesity is covered when deemed medically necessary,” or “Surgery for the treatment of obesity is (specifically) excluded except when medically necessary.”
Below we list companies that have been known to either partially or completely cover LAP-BAND System surgery in Illinois. Please note that this list in no way insures that you will be covered or that we are in their network — it is provided for informational purposes only.