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Does PacifiCare Cover LAP-BAND Surgery?

Does PacifiCare Cover LAP-BAND Surgery?

PacifiCare will cover your LAP-BAND Surgery as long as you meet your insurance plan’s requirements for bariatric surgery. While you can review your insurance policy package to see what weight control or bariatric management expenses are covered or excluded, you may find it easier to simply give us a call at 855-690-0560, or fill out our free, no obligation FREE LAP-BAND Insurance Verification Form so that our LAP-BAND Insurance Coordinator can verify your PacifiCare LAP-BAND Surgery coverage for you. There is absolutely no obligation to have us verify your LAP-BAND coverage and if you don’t meet your insurance policy’s criteria, we can request an individual need assessment, send a letter of medical necessity and help you through the appeal process if necessary.

PacifiCare LAP-BAND Coverage

Just as each person is different; PacifiCare’s LAP-BAND Coverage and pre-approval criteria varies with each insurance plan and prospective patient. Prior to covering any bariatric surgery, PacifiCare may require a Body Mass Index (BMI) of 35 or greater along with a written letter describing your weight history for the last 5 years including all attempted diets, exercise and weight loss programs. You may also be required to undergo a 6 month supervised diet (nutrition evaluation) and a psychiatric evaluation prior to qualifying for PacifiCare’s LAP-BAND Coverage. If Your BMI is below 40, PacifiCare will also evaluate your weight-related medical conditions prior to granting your authorization for a LAP-BAND Surgery.

PacifiCare LAP-BAND Requirements

You may automatically pre-qualify for PacifiCare to cover your LAP-BAND Surgery if:

  • You are 100 pounds or more above ideal weight, or
  • You have a Body Mass Index of 40 or greater, or
  • You have a Body mass Index of 35 or greater and suffer from a life-threatening or disabling problem that is related to your weight such as type 2 diabetes, sleep apnea, or hypertension.
  • You have been overweight for at least five years, and
  • You have failed all weight-loss attempts including diets, exercise and weight loss programs.

To see if your PacifiCare Insurance Plan covers the LAP-BAND Surgery, please call us at 855-690-0560, or fill out our FREE, No Obligation LAP-BAND Insurance Verification Form and we will verify your PacifiCare LAP-BAND coverage for you!

Although PacifiCare was acquired by UnitedHealth in 2005, UnitedHealth continues to market health plans under the PacifiCare brand name with more than 3 million health plan members and approximately 10 million specialty plan members nationwide.

Disclaimer: This site is not affiliated with or endorsed by Pacificare and is for informational purposes only - The following Pacificare LAP-BAND guidelines have been compiled from various public sources. It is presented online for informational use only, and without warranty as to its accuracy, timeliness, or completeness. This site does not replace any official versions of the information presented, nor does inclusion on this list guarantee coverage. Please check your Pacificare policy before proceeding with your surgery.