bummed

[mkmischo 0]

my insurance is being a total pain in the butt saying I don't fit their criteria because my co morbid condition is hyperlipidemia, which for most insurances is not considered a co morbid condition but cigna lists it as such and is still denying me! how many self payers out there?:wub:

[KateTheGreat 0]

That's so frustrating!!! Their criteria says

" a BMI (Body Mass Index) ≥ 40

a BMI (Body Mass Index) 35–39.9 with at least one clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension"

They don't list everything because they want a reason to rule you out. LAME. I'd definitely file an appeal. Have you been tested for obstructive sleep apnea?

[babiegirl 0]

i was denied 2 times but my dr called insurance and got me approved. so just keep appealing till they approve you.

[caffeine 0]

I have to agree with Kate.

One co-morbidity you can claim is weight related joint pain. When you pass a certain point, your ankles, knees, and possibly hips hurt on a day to day basis. It was true for my case. It can be true for your case. Just document it with your PCP and bariatric surgeon's coordinator.

Another is hypertension. I've never met someone with a BMI of greater than 35 that did not have some form of hypertension.

The great thing about hypertension is that although it is a *spectrum* (you can have kinda high, high, very high, dangerous, etc) on most doctor forms, it is stochastic: you either have it or don't have it.

If you take something like hydrochlorothiazide, then ipsofacto, you have hypertension.

Perhaps it would be appropriate to talk to your PCP about getting you on a "baby dosage" of hydrochlorothiazide? I had slightly elevated heart rate and my doctor prescribed 12.5mg/day, considered a "baby dose". For me, there were no side effects at this level (the main side effect being having to pee a lot).

[caffeine 0]

Just out of curiosity, why did you choose just one co-morbidity?

You are making a case. You are basically arguing with someone, trying to convince them that you need something. Even if it says "one" co-morbidity, you want to give them a hundred co-morbidities.

You want to show Cigna that if they DON'T pay for your surgery, they will end up paying a SHITLOAD of money to treat your joints, coronary disease, diabetes, etc.

Remember: You want to make an economical case, not a health case. An insurance company is a for-profit business. You want them to shake in their boots about not giving you the procedure.

[caffeine 0]

Going through all my paperwork, tossing out stuff I don't need. Found my PCP's letter of medical recommendation and thought it might help you if I shared it. These were my co-morbidities:

1. Glucose metabolism

2. Hypertension

3. Musculoskeletal disease

4. Obstructive sleep apnea syndrome (no study)

Diet history:

Atkins, calorie counting, self diet, weight watchers, and medication Adipex-P (Phentermine)

Impression:

Peter is a 40 year old male with a BMI = 38.9 which places him in the morbidly obese category. This has directly contributed to his medical condition such as Glucose Metabolism, Hypertension, Muscularskeletal disease, and Obstructructive sleep Apnea Syndrome, as well as, a decreased quality of life.

[KateTheGreat 0]

I have to agree with Kate.

Another is hypertension. I've never met someone with a BMI of greater than 35 that did not have some form of hypertension.

Perhaps it would be appropriate to talk to your PCP about getting you on a "baby dosage" of hydrochlorothiazide? I had slightly elevated heart rate and my doctor prescribed 12.5mg/day, considred a "baby dose". For me, there were no side effects at this level (the main side effect being having to pee a lot).

Actually, I have a BMI of 38.1 and I've always had excellent bp--- 110/60:)