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Insurance For Weight Loss Surgery: It Might Be Harder Than Weight Loss Itself
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Insurance for Weight Loss Surgery: It Might Be Harder Than Weight Loss Itself

Getting your health insurance company to approve your bid for weight loss surgery might be harder than trying to get fit the old fashioned way, warns some experts. This news comes despite a recent change in Food and Drug Administration (FDA) standards that have lowered the body mass index (bmi) range for one popular device. Allergan's Lap Band device can now be used for people who are in a lower bmi target range than previously had been approved. In the past, the Lap Band was only allowed for people who fell in the upper range of 35-40, but a clinical trial held this past spring spurred the FDA to drop the range to 30-35 with certain restrictions.

But, despite the fact that the FDA made the changes, insurance companies are still reluctant to make changes to their own approval policies, continuing to deny many people who try to get the surgery. Some people, in an effort to get the surgery have tried to gain even more weight or try other methods of worsening their health. Insurance companies typically pay for the weight loss surgery if there are additional, underlying health problems related to weight such as high blood pressure or heart disease.

Doctors and health care advocates are warning that being denied for weight loss surgery and then purposely gaining more weight will not automatically get your case approved and may in fact be considered fraud by the insurance companies. They also warn how dangerous that concept can be.

The FDA decision to lower the accepted range for the lap band means that nearly thirty million more people are technically eligible for the process but that doesn't mean that they will get it. According to statistics, slightly less than one percent of those who are eligible will actually get the lap band surgery, usually because of the expense.

Insurance companies frequently suggest that patients use methods that are less risky and non invasive like medically supervised weight loss programs and other plans. But, when everything has been tried and failed, many of them are forced into allowing the surgery to go forward.

BMI, long used as the health and fitness standard by insurance companies is not always considered to be perfect by the medical community. Currently, however, it is the number that decisions are being based on. A person that is 5'6" that weighs in at 220 pounds will have a bmi of 35. Just thirty pounds more puts the bmi up to the upper range of 40.

Weight is a growing concern world wide, with obesity rates skyrocketing. In the United States, nearly two thirds of all adults are either overweight or obese.


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