Depending on your insurance and physician recommendations, the cost of lap band surgery in Texas may be covered by insurance or Medicare. There may be tests or programs that you will be asked to complete prior to having the lap band surgery. Typically, basic lab work and X-rays are required, however, other tests could include an EKG, sleep study, or a stress test. Other requirements could be a 4- to 6-month weight loss program, physical therapy, or visits with a nutritionist or psychologist.

In the early stages of the approval process, a lap band surgery  advocate or clinical staff member will discuss with you what tests and programs the doctor has ordered, what your insurance requires, and any other items that may be necessary for you to address prior to surgery, based on your personal health assessment.

Depending on your insurance, there may be a portion of the hospital bill that you will be responsible for. This amount is separate from any fee(s) that the surgeon’s practice may charge you. One of our financial counselors will contact you prior to surgery to make sure you are aware of your potential financial responsibilities.

While the NIX Health Care System accepts most major health plans, including Medicare, for surgical weight loss procedures, benefits and coverage vary by insurance company. We recommend that you contact your insurance company directly to familiarize yourself with your surgical weight loss benefits and any particular costs or requirements.

The lap band surgery procedure continues to be the least-expensive surgical weight loss procedure, falling under the cost of gastric bypass in San Antonio by several thousand dollars.

Insurance Verification

To determine if your insurance policy covers the cost of lap band surgery, refer to the insurance policy package that your have received after paying yur first insurance premium or that is provided through a plan offered by your employer.

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." If this surgery is a covered benefit when medically necessary, then it should be covered when patients meet national guidelines for care for morbid obesity.

Below is a list of companies that are known to either partially or completely cover weight loss surgery in San Antonio. Please note that this list in no way ensures that you will be covered—it’s provided for informational purposes only. Coverage is determined at the employer’s discretion.

• Blue Cross Blue Shield
• Aetna
• United Health Care
• Humana
• Cigna
• Harrinton
• First Health
• GAHA
• Lancer
• Medicare
• Tricare
• Humana Medicare Advantage
• Secure Horizons
• Elder Health
• Wellmed
• Aetna Medicare Advantage
• United Medicare Complete
• GreatWest
• Pacificare
• PHCS
• SAEHA
• Benefit Planners
• Texas True Choice Star
• COSA
• UHC-Choice and UHC Options
• Community First HMO

Submission Requirements

• Patient’s weight (which should be 100 pounds or more above ideal weight or a BMI of more than 40 or at least 35 with associated medical problems to qualify)
• List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.
• Number of years patient has been overweight (which should be at least five or more)
• Number and types of failed weight-loss programs attempted in the past

If you create a document or packet listing all your weight loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the cost of lap band surgery. You should include any commercial diets or medical records of your weight loss efforts.

Alternative financing is available if your insurance does not cover the cost of lap band surgery in Texas. Please contact your bariatric surgeon’s office directly for more information.

A Letter of Medical Necessity and weight loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information: