Expert: Karla K. - 2/19/2009

Question
hello. My question, does medicaid cover the lapband surgry on a 15 yr old?  He has full medicaid coverage. thank you

Answer
Hi Lorie:

It might.  I know that's not the exact answer you want, but it's the best I can do.  If the 15 year old is morbidly obese (with a BMI over 40), there's a chance medicaid could cover the surgery.  (Or if he has a BMI over 35 plus a comorbidity like diabetes or sleep apnea.)  Usually, insurance companies do not cover bariatric surgery for teens, but the initial reports out of the Lap-Band Trial for Teens are promising... so you could definitely try.

Basically, you're going to need your child's pediatrician to be on board...and then seek out a bariatric surgeon experienced with adolescent patients.

To figure out BMI, try this website: http://www.nhlbisupport.com/bmi/

For a good Lap-Band doctor, I recommend asking on one of the Lap-Band Forums such as Lap-Band Talk.  www.lapbandtalk.com  

You should also check out your surgeon with your state's medical board
http://www.fsmb.org/directory_smb.html

And also check to see if s/he is board certified at
https://www.abms.org/WC/login.aspx

I hope this helps,

Karla