Does health net pay for lab band surgery?

Answer 1

In order to be approved by Health Net for lab band surgery, you must meet the following criteria: Adult Requirements

1. Patient is an adult under 65 years of age (unless the patient is > 65 years of age and is considered a low-risk candidate for surgery)
2. For at least 2 years or greater, the patient has clinically severe obesity (morbid obesity)
3. Patient has made a reasonable effort to lose weight and chart notes must document that these attempts at dietary control have been ineffective in achieving a medically significant long-term weight loss.

   Published peer-reviewed studies have shown that superobesity was the most important risk factor for perioperative complications, during bariatric surgery. Although patients undergoing bariatric procedures invariably have a history of failed dieting, preoperative weight loss can improve patient safety for these procedures. Aggressive medical therapies, such as very low calorie diets, are transiently effective for morbidly obese patients. The major limitation of medical obesity treatments for these patients is generally unsustainable weight loss rather than an inability to lose weight at all. Given these circumstances, preoperative weight loss can prove to be a reasonable approach to reduce adverse outcomes for superobese bariatric surgical patients but is not required prior to surgery.

4. All patients must undergo a preliminary psychological evaluation by licensed mental health care professional (LCSW, MFCC, MSW PhD) familiar with the implications of weight reduction surgery. If pathology is identified, then an evaluation by a psychologist / psychiatrist is required and the member must receive clearance before surgery is performed.