Questions about Lap Band Surgery

Hi all,

This is my very first post on this forum! I have been lurking here for about 2 days, so I figured it was time to join in the discussions. 

I am starting to seriously consider WLS.  My primary care provider and OB/GYN have both suggested that I get WLS.  I have been exercising, and dieting, but it seems to yield very little results and that is FRUSTRATING!  So now I am seriously considering the Lap Band, mainly because I concerned about the complications of RnY surgery, plus its supposedly cheaper, and I would be less likely to get the hanging skin (I hope) since the weight-loss is slower (correct me if I am wrong about any of the aforementioned assumptions).

My one concern regarding the WLS is the out of pocket costs.  I have been hunting, and searching and even quesitoning someone I know about how much Lap Band surgery costs, and nobody will give me a straight answer.  From what my insurance company tells me, I will have to pay out of pocket, 20% of the total cost of surgery.  I also think there are some hidden fees related to surgery that insurance won't pay (if anybody knows about some hidden fees, please tell me).

My questions are:

How much does Lap Band Surgery Cost??

Were there hidden fees?

How has your Lap Band weight loss experience been, and why did you choose it over RnY?

Thanks for your help.  The success stories I have read here are very encouraging. 

Hi!!!  I have BCBS of NC, and I had Lapband about 5 months ago.  My out of pocket was about $3500.00, that included my deductible, my 20%(had not met my out of pocket ), and the physicans fee.  I think that the hospital billed my insurance about $16,000-- 18,000.00, but they can only use your insurance allowables.  You should call your insurance first, find out if WLS is covered, then find out the benefits (deductibles/out-of pocket), and go from there.  I've lost 30 pounds so far, and I have been pleased so far, I also choose LapBand over RNY because of the possible complications, and the lifelong commitment of taking meds..Good Luck

HI Daybreak,

I have a few questions as well if you don't mind.  I too have been considering Lap Band for many reasons mostly because of fewer complications and possibility of reversal if necessary.  Also, one of my co-workers had it about 7 mos. ago and she doesn't have the sagging skin that I've seen with Gastric Bypass.

I also have BCBSNC and I believe the max my policy will cover is $10,000....so does that mean that my out of pocket would be somewhere between $6,000 and $8,000 or does the hospital bill according to the policy max?

Was it hard for you to get approved and how long after you started the process did you actually have the surgery?

Also, how was your surgery?  Were there any complications?

One more thing, what type of leg work did you have to do to get approved?  I don't really visit a primary care physician but do go to the OBGYN often who has an 8-10 year history of my weight.

Thanks for answering my questions!

I don;t know about the maximum on your policy?? I started my own process in Jan. 2008, and I had my surgery on March 27, I had alot of work already completed.  For example, I had my yearly female physical,labwork (PCP), pysh evaluation (but I would see what physican your Dr. prefers), and I had gathered my 5 yr. weight history so that I would be prepared.  My surgery was outpatient in at 5:30am and home by 2:00pm, of course I was alittle sore, not bad though.  I would recommend walking as much as possible, to keep the gas at bay.  The only problem I had (still have sometimes) is left shoulder pain, I think that it is referred pain from the abd. surgery, but it is nothing that I need medicine for.  Good luck, please feel free to contact me if you have any questions....

**your records from OBGYN will be fine as long as it shows your weight for 5 years consective.

Please excuse typos-trying to get kids to bed...

I insurance pre-certs for a local doctor and figure the co-insurance out for every patient. The cost varies greatly from doctor to doctor  (as their contracted rates w/ the insurnace companies are probably differnet) so there is no real way to tell you right now how much it would be for you to have surgery. Some polices have a deductible then you have your co-insurance (like 80/20%), and most have an out of pocket max. So the out of out of pocket max plus your deductible is the most you would expect to pay for your calendar year for your insurance. I know this probably doesn't make any sense but if you will call your doctors office and speak to their insurnace rep they should be able to help you better. :-)

I will tell you that the contracted rates for the band are less then the RNY for the MD's and then most bands are done as outpatient vs inpatient w/ the RNY. So that will cause the hospital fees to be less.

Not sure what "hidden fees" are are speaking of. A lot of offices have program fees but they will normally tell you that when you attend the seminar. There could be out of pocket for psych, fitness and nutrition.

Good Luck! (for me personally it was the best choice that I have ever done!)

Hi. I am glad that you decided to join in the conversations. I had lapband surgery 4 years ago before any insurance companies would pay for it so I cannot answer anything about your insurance questions but I will ditto the comment that it was the best thing that I ever did for myself and my health. I have never regretted getting my band even though I had to pay every blasted cent!

My insurance didn't cover anything, so I was self-pay ($8500 in Tijuana).  My husband has Medicare and a Med Sup, so his won't cost anything.  As for the "hidden fees" you are referring to.  Possibly all of the tests and bloodwork.  Not sure if those would be ALL covered by the insurance.  For instance: the cardiologist NP has decided my husband needs a stress test, would that normally be covered by your insurance?  Also, be sure to check into what fills are covered.  Is it a certain number?  or for a certain length of time?  ie: - if it is a year's worth, you may only need 3 fills in 12 months, then another yearly after that that you would have to pay for yourself.  If it covers 6 fills, that could be enough fills for 2 or 3 years of fills. 

The very best thing to do is call your insurance co.  If you don't want your employer or coworkers to know about your WLS, go directly to the ins co, NOT to your HR person.

Unfortunately, I had to delete this post due to privacy concerns.

Hi Shelli,

Actually your Dr., Paul Enochs, is the surgeon I am considering.  I went to the seminar on the 12th and filled out my insurance info, but have not heard back from them about how much I will have to pay. 

When you had your surgery, was it at Rex or Wake Med?  Did they make you pay all of your part upfront before doing the surgery or did they bill you for the amount you owed?  Right now, having all the money all at once is my biggest concern.  I want to start moving forward toward surgery, but I don't want to do everything and then when its time for surgery find out I don't have all of the money saved up to pay my part.

Unfortunately, I had to delete this post due to privacy concerns.