Question:
Why would insurance cover a procedure 100 % Open vs Lap 70%

I have Promina Inusrance POS and they will cover my procedure for open at 100% but same procedure RNY Lap at only 70% any one know why this is the case?    — [Anonymous] (posted on September 9, 2000)

September 9, 2000
FYI: Laparoscopic surgery requires 2 surgeons instead of one and takes twice as long (this is as it was explained to me by my surgeon). Many insurance companies will not pay the for lap because, quite simply, it costs more money, and the results are not so different post-op -- you simply get to avoid the 4-6" scar, but the insurance is more concerned about the overall outcome. And cost is ALWAYS their BIGGEST issue.
   — Michelle F.

September 9, 2000
My understanding is that open also requires an assistant surgeon. I also believe that it is total cost of surgery being higher with lap. My guess to higher cost factors: elapsed surgical time, laproscopic equipment, staffing, more anesthesia time? Does anyone remember elapsed surgical time open vs lap??
   — JennyLynn A.

September 10, 2000
The ins cos might not think lap is better and therefore not want to pay the costs...but my friend/neighbor is also my doctor and she says she would take the lap over open any day...so on my surgery I don't care the cost diff..I'm going for the lap
   — Debora H.