Lap-Band insurance coverage is a controversial subject. On the one hand, many Americans believe that being overweight or obese is a personal "choice," and that if an obese person chooses surgery over lifestyle change, insurance should not cover something that costs thousands of dollars when the alternative is free.
On the other hand, many Americans also believe that with the obesity crisis consuming almost $150 million in annual health care spending, anything that can prevent the continuing spread of obesity is a worthwhile investment. Obesity-related diseases certainly affect the workplace, so why shouldn't companies and insurance plans cover a procedure that would allow workers to be more productive?
What is Lap Band Surgery? The Lap-Band, one of several types of adjustable gastric bands (AGB), is the name of a trademarked AGB made by Allergan Inc. The surgery, which is one of several types of weight loss (bariatric) surgery available, consists of the placement of a silicone band around the upper portion of the stomach to limit the amount of food that can pass into the stomach.
A pre- and post-operation diet of liquids is necessary, and post-op the diet changes gradually back to solid foods. However, portions are much smaller afterwards because a person with a band cannot keep down a large amount of food in the small "pouch" that is created by the band. Extensive follow-up is indicated to make sure the patient is eating correctly and not committing any self-harm by not implementing the necessary changes in eating habits.
Who is it for? Currently, the surgery is FDA-approve only for the morbidly obese, or those with a body-mass index (BMI) of 40 or higher. For example, a 5'8" person who weighs 260lbs has a BMI of 40. However, the FDA recently granted Allergan's request for permission to market the device to people with a BMI of 35, or even as low as 30 if they have a related health problem. The same 5'8" person would now only have to weigh 230lbs, or as low as only 200lbs if they have an related health problem. This effectively doubles the surgery-eligible population.
What Expanded Approval Could Mean Currently, the operation costs between $12,000 and $20,000 (with the device itself costing $3000) and is usually covered by insurance if the 40+ BMI criterion is met. However, the copay is still a few thousand dollars. Patients who currently are under a BMI of 40 but choose to get the surgery anyway are technically using it "off-label" and are most likely not covered by insurance.
For the person who is not extremely overweight and believes that they have tried losing weight by diet and exercise and has been unsuccessful time and again, this could be the answer.
In this economy, fewer people have been getting this surgery because of the expense. Expanding availability most certainly means expanded insurance coverage. Allergan Inc. would also be able to sell a lot more of these devices.
However, this could also mean more people opting for surgery instead of actually trying lifestyle change, which costs less but requires more mental and emotional effort on the part of the patient. Ironically, the only way that the Lap-Band continues to be effective over time is if the patient actually does implement changes in eating and lifestyle habits.
There are also risks associated with this procedure, including the 1 in 1000 death rate. People may opt for surgery while being unaware of these risks, and we may see a whole new set of problems stemming from expanded approval of Lap-Band placements. Moreover, the surgery doesn't produce results in all patients, either because it requires removal due to complications or the patient does not adhere to the required post-op diet.
The Real Costs of Losing Weight There is no doubt that obesity is a real problem with apparently no real solution. It is draining our health and our economy. However, creating the idea that a BMI over 30 is a problem that might require a $20,000 procedure may not be the best way to keep money in the pockets of the average American, and it might not teach Americans how to actually eat and live healthier. Surgery, with all of its risks and expense, should be reserved for the last resort.
Expanding Lap-Band insurance coverage may make the out-of-pocket costs of the procedure appear to be a rather small investment. But spending a couple of thousand dollars for a surgery that may or may not work, and that may or may not leave someone with lifetime complications, seems like a risky investment to make before actually committing seriously to a program of nutrition and exercise.
Losing weight through a healthy diet may seem challenging and expensive, but certainly it is not as expensive as the surgery itself and the associated costs that come with it, including the potential complications. There are great programs, plans and people out there willing to help patients lose weight in a healthy and affordable way, and without surgery if they really want to. Some people have results on programs that cost no more than what they spend on regular food, while producing weight loss results comparable to those people who have had the Lap-Band surgery. The missing link for people who have tried to lose weight on their own might be a health coach or counselor, rather than surgery.
Doctors should require that pre-op patients adhere to a two-month program of lifestyle change in order to qualify for surgery. The program should be covered by insurance and come complete with a health coach and accountability system to determine whether or not they are truly incapable of losing weight on their own. The result might be a lot more healthy people, and a lot more lives improved, a lot fewer complications, and a lot less money spent.
Belinda Kan is a Certified Health Coach whose helps her clients lose weight quickly and safely on the Take Shape For Life program. Her clients lose an average of 15-20lbs a month without surgery, drugs, or extra food costs.
If you want to learn some easy and economical ways to start incorporating some of these healthy habits into your life, you can download a free guide called "How to Eat Healthier with Limited Time and Money" on Belinda's website, http://www.HealthyAffordableWeightLoss.com. There you will get information on healthy weight loss and weight maintenance strategies.
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