Comorbidities

[Wisdom2KnowTheDifference 32]

I know this is a really personal question, but I would like to know what comorbidities people have submitted to insurance to have procedure approved. I have BMI 36 and comorbidities are relatively minor compared to some (shortness of breath, thermoregulation issues, depression, varicose veins/venous insufficiency). Oh, and my insurance company says they don't cover WLS. So I am trying to figure out what kind of a shot I have submitting my doctor's letter. Thanks!

[gottobeme 81]

I had impaired fasting glucose, depression and sleep apnea. My BMI was 46 when I started my WLS journey and under 35 by the time I had surgery. My insurance - which is affiliated with the clinic I go to - uses the BMI you start the program with.

[DELETE THIS ACCOUNT! 12,703]

Most insurance companies won't even accept the things you listed as comorbidities. They are looking for things like sleep apenea, high blood pressure, and diabetes. All require proof they exist, too.

The guidelines have gotten a lot tougher for most and the reason being Medicare changed their requirements and most companies follow their cue in their own guidelines.

I would find out from your insurance company directly if there are any circumstances in which they'll cover it and go from there,

[Sojourner 2,446]

Serious comorbidities are the only way that my insurance company will even consider a patient for WLS if their BMI is under 40.

You have to stress the medical rationale that having the WLS will in the long term end up saving them money with fewer medications, fewer hospitalizations, longer life expectancy.

In his letter of medical necessity, my physician included all of the language the insurance company required, such as the long term savings to the company and the causal relationship with the condition to the weight. Also, you had to prove, though 3 years of medical records that you had repeated attempts to loose the weight without surgical intervention. Only the more serious of the comorbidities will rate consideration, such as weight related osteoarthritis (requiring joint replacement), GERD, hypertension, and insulin resistance/borderline Type II Diabetes.

I believe it also helped that my physician had done the required medically supervised diet for several other of his patients, and is knowledgeable about the insurance requirements and what to include in his letter.

[Cazzy 725]

I think the clue to what a co-morbidity is is in the title, it has to be something that if left untreated out of control could lead to your demise i.e it affects your mobidity, or its something that if left untreated wouuld cost the insurance company vast sums of money

U need to find out if they have ever funded WLS and what the criteria for it is, they may do a general NO we dont do it, but u need to find out if there are excepetions

[Dollgirl 8]

Hi. My comorbidities include type 2 diabetes (insulin-dependent), depression, and joint problems. I hope this helps.

[cfmom716 8]

There are many. Gall stones:

• Gerd (acid reflux)
  
• leg or joint pains,
  
• diabetes,
  
• high blood pressure,
  
• depression,
  
• edema in ankles, legs or hands,
  
• back pain caused by weight,
  
• high cholesterol,
  
• severe skin problems do to obesity,
  
• bladder incontinence,
  
• sleep apnea,
  
• impairment in moving causing you to have difficulties daily,
  
• gynecological.
  

I hopes this helps, Good Luck!