Denied due to Comorbidities

[fisher08 0]

I just heard from my insurance company and they denied my claim stating that I did not have valid comorbidities? The comorbidities that my dr. listed for me are high blood pressure, high cholesterol, reflux, osteoarthritis. Are these not valid comorbidities?

The surgeon has scheduled a peer to peer review with the Medical Director. Can anyone tell me about these?

[DELETE THIS ACCOUNT! 12,703]

Unfortunately it varies from one insurance company to another.

If I were in your shoes, I'd get in writing exactly what they consider to be co-morbidities. This way you'll know exactly what they're looking for.

Best wishes.

[GoingforGoal 1,734]

Hi Fisher,

Sorry to hear about your setback. Definitely file for an appeal, it doesn't hurt.

As for the co-morbidity issue... I noted that your BMI is under 40. Depending on your insurance, a co-morbidity may be a requirement if you don't meet the minimum BMI (my insurance was 40). Some co-morbidities like sleep Apnea, Diabetes, heart disease etc are imminent diseases that are life threatening. Additionally, these diseases cost insurance companies far more in the long run than the LB procedure. However, other co-morbidities such as elevated blood pressure and cholesterol is questionable and not always obesity related. First, how elevated are your labs and are there any sign of disease from these elevated levels. Have you been previously diagnosed and treated for these conditions, has your treatment been successful in managing these levels. If there is not a extremely high level, the insurance company may disregard it and not associate the obesity as having any negative impact on your body (yet).

Garbage, I know. But it's the game we all play