There is no single price for Lap-Band care, because the cost depends on what is being done. A fill in the office, an X-ray study, a port repair, a band removal and a conversion to a sleeve or bypass are different services, billed in different ways. Your insurance design and where the procedure happens change the total too.
Different kinds of band care, different costs
| Service | What it involves | What tends to drive the cost |
|---|
| Fill or unfill (adjustment) | A needle into the port under the skin to add or remove saline | Whether it is done in the office or in an X-ray room, and how many visits are needed |
| Tests | Upper GI X-ray (barium swallow) or endoscopy (a camera exam) | Radiology or facility fees, and sedation for endoscopy |
| Port or tubing repair | A small operation on the port or tubing only | Operating room time, anesthesia, parts |
| Band removal | Laparoscopic removal of the band and port | Scar tissue, operating time, anesthesia, facility |
| Conversion | Removal plus a sleeve or bypass, in one stage or two | Which operation, whether it is one or two operations, hospital stay |
The FDA patient guide notes that adjustments may be done in the X-ray department so the port can be seen clearly. That is one reason two fills can be billed differently. At the Rancho Cucamonga office, fills are done under x-ray guidance. Our guide to tests for Lap-Band problems explains what each test shows.
How a bill is put together
For anything done in an operating room, you may get several bills: the surgeon's fee, the facility (hospital or surgery center), anesthesia, and sometimes radiology or pathology. These are often charged separately.
Procedures are billed with standard codes. The Medi-Cal provider manual, for example, lists separate codes for placing a band, revising it, removing it, removing and replacing it, and removing the band together with the port, plus separate codes for port-only repair or removal. Aetna's policy lists a separate code for adjusting a band through the port. If you know which code your surgeon expects to use, you can ask your insurer what you would owe for that code.
A conversion done in two stages means two operations, and usually two sets of facility and anesthesia charges. Our guide to one-stage versus two-stage conversion explains the medical reasons for each.
How insurance changes what you pay
If your plan covers the service, your share depends on your deductible, copays and coinsurance, and on whether the surgeon and facility are in your network. Most plans need prior authorization (approval before the service) for surgery.
Whether the service is covered at all is a separate question. Aetna's policy notes that some of its plans exclude obesity surgery entirely, and Cigna's says coverage for bariatric surgery or revision varies across plans. Insurers also treat band removal for a complication differently from revision for weight regain. Our page on insurance for band removal and revision explains how those decisions are made.
If you are paying yourself
Federal rules give people who are uninsured, or who choose not to use insurance, the right to a Good Faith Estimate. According to CMS, it should list the expected items and services with their expected charges. If you schedule at least 3 business days ahead, you should receive it within 1 to 3 business days, depending on how far ahead you book.
For taxes, IRS Publication 502 says you can include amounts paid to lose weight if it is treatment for a specific disease diagnosed by a physician. Ask a tax professional how this applies to you, and check your plan's rules before using health savings or flexible spending account funds.
The Lap-Band cost page covers paying for a first band. The office will explain current self-pay options and any financing by phone.
What to ask before you agree to care
- What exactly is planned, and which procedure codes will be billed?
- Is the estimate itemized, and does it include the surgeon, facility, anesthesia and any imaging?
- What follow-up is included, and what is billed separately?
- Is everyone involved in my plan's network, and has prior authorization been requested?
- If a second stage is needed, is it part of this estimate?
Frequently asked questions
Is a band fill usually covered by insurance?
It depends on your plan. Cigna's policy, for example, treats adjustment as medically necessary to control weight loss or treat restriction symptoms after a medically necessary band operation. A plan that excludes bariatric care may not pay for fills at all. Ask your insurer before your first fill, and bring your card so the office can check.
Why might removal and conversion cost more as two operations?
Each operation usually carries its own facility, anesthesia and surgeon charges, so two stages can mean two sets of bills. Two stages are chosen for medical reasons, not for billing. Ask whether your estimate covers one stage or both, and whether each stage needs its own authorization.
Can I use HSA or FSA money for band care?
Possibly. IRS Publication 502 treats weight-loss costs as a medical expense when they treat a specific disease diagnosed by a physician. Health savings and flexible spending accounts each have their own rules and paperwork, so check with your account administrator and keep itemized receipts for every visit and procedure.
What is a Good Faith Estimate and how do I get one?
It is a written estimate of expected charges that self-pay and uninsured patients are entitled to under federal rules. CMS says to request it, or schedule your service, at least 3 business days ahead. It should be itemized. Keep a copy, because it helps if the final bill is very different.
Talk with Dr. Davtyan in Rancho Cucamonga
Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon. The practice works with PPO and HMO plans that allow care with Dr. Davtyan, and the office can check your benefits and explain costs before you commit. Call Davtyan Medical Weight Loss & Wellness at 909-355-2525 or use the contact page; the office is at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. More topics are in the Rancho Cucamonga Lap-Band guide.
Sources
More in the Lap-Band in Rancho Cucamonga guide
Start at the Lap-Band in Rancho Cucamonga page, or go straight to a topic.
Understanding your band
Weighing your options
Getting care in Rancho Cucamonga
