Frustrated

[Texie 0]

I am new to the forum! I have been reading over so many of your posts and everyone is so informative! Thanks so much!

I have been looking into getting the lap band for a while now and my insurance would not cover it or any WLS. Now, I know that it was a blessing in disguise because I likely would have regretted the lap band with all the complications. Anyway, this year our insurance began covering WLS (Aetna)! I was so excited and finally got the nerve up to schedule an appointment a couple of weeks ago and went in with full intentions of the lap band. My Doctor pretty much talked me out of it! He is all for the sleeve. After much research, I am very sure that the sleeve is right for me.

Now, for my frustration... I am at a 36 BMI and aetna requires a comorbidity with anything below a 40. I was sure that I had sleep apnea, as was the rest of my family. They have even recorded me sleeping to prove to me my problems. So... sleep study it was. I went to have a sleep study and could NOT sleep. I slept for a grand total of 170 minutes all night long. Not all at once, but in increments. The longest I slept at one time was 45 minutes! I get the call yesterday with my results and they said I do NOT have sleep apnea. I questioned this because I knew I had not slept well and they said that I had stopped breathing an average of 4 times per hour (required for sleep apnea is 5)! I asked that they request another sleep study because there was no way that this was conclusive because I did not even enter into REM sleep. They are checking with my insurance to see if they will pay for it again. I am angry because the center should not have even had conclusive results!

Has anyone else had this problem or does anyone have any advice on what to do now? I do not have heart problems or high blood pressure, so this is my only chance. Not that I WANT sleep apnea, but I just know I have it. I have 4 out of the 5 symptoms that they asked me about and I have heard myself snore and stop breathing!

Thanks in advance for any help!

Edited May 6, 2010 by Texie

[Tiffykins 673]

Hi and welcome. I hope you can get another sleep study, and possibly have it completed at a different sleep center for a true 2nd opinion.

As for other co-morbidities, do you have any joint/back pain, borderline diabetes, cholesterol issues, thyroid issues, PCOS, GERD, some of those are considered co-morbidities by some insurance companies.

I hope you can get another sleep study, and keep us updated on your progress.

[Trinity321 0]

With a BMI of 36, that means you are overweight. How far are you from your goal weight?

[Texie 0]

Tiffy~ I have PCOS, however, my insurance only considers the top 3 as a comorbidity (heart problems, high blood pressure or slep apnea).

I did get a call back after my post and they scheduled me for a new sleep study. I did it last night and slept very well. Sooo... I am hoping that they were able to get good data! I will keep ya'll updated.

Trinity~ My goal is to loose about 80 pounds. That would put me right in the middle of what the tables show as my healthy weight. With a BMI of 36, yes I am overweight and even considered to be morbidly obese.

Thanks for the replies! Cross your fingers that I am able to get this surgery. I have tried so many things, only to lose the weight and come back even heavier than before!

[Tiffykins 673]

Tiffy~ I have PCOS, however, my insurance only considers the top 3 as a comorbidity (heart problems, high blood pressure or slep apnea).

I did get a call back after my post and they scheduled me for a new sleep study. I did it last night and slept very well. Sooo... I am hoping that they were able to get good data! I will keep ya'll updated.

Trinity~ My goal is to loose about 80 pounds. That would put me right in the middle of what the tables show as my healthy weight. With a BMI of 36, yes I am overweight and even considered to be morbidly obese.

Thanks for the replies! Cross your fingers that I am able to get this surgery. I have tried so many things, only to lose the weight and come back even heavier than before!

That is awesome you got another sleep study. Definitely keep us posted.

I hate that insurance companies only "recognize" certain co-morbidities. I want to scream "Hey, a$$wipes, all of them can kill us, why be picky about the ones we're allowed to have."

Sorry, it's one of my pet peeves.

I've my fingers and toes crossed for you ! ! !

[cwalker 12]

I know this sounds crazy but all my life when asked my height I always rattled off 5'9" so imagine my suprize when the Dr. measured me and I was a full inch shorter and it definitely rasied my BMI. It's worth a shot anyway if the second sleep study doesen't come through for you. Carla

[educationrulz 18]

I know this sounds crazy but all my life when asked my height I always rattled off 5'9" so imagine my suprize when the Dr. measured me and I was a full inch shorter and it definitely rasied my BMI. It's worth a shot anyway if the second sleep study doesen't come through for you. Carla

I had the same experience Carla. I've always said that I was 5'4". When I got my height taken at my first PCP supervised diet visit, I was 5'3". Now I could have sworn that someone had measured me at 5'4" sometime in the past so I must have some age shrinking going on.:thumbup1: I didn't need the extra inch for BMI purposes but it could definitely make a difference for some people.

[jrosewell100 0]

Hi: I would push for a second sleep study. Explain your issues. I had a issue because I am a night worker and am use to sleeping during the day. Stay awake for an extended period of time to be sure that you are tired. Do you have other co-morbidies. Are you diabetic, high cholestrol, high blood pressure, or arthritis. Sleep apnea is the one that makes the insurance companies pay off. It is very costly for them to pay for the c-pap machines, and all the supplies that come with it. Aetna, Blue Cross and United are the 3 that are the best at approving the surgery. They have come to understand that doing nothing is far more costly for them than if they approve the surgery. Beside paying for the c-pap machine, the cost of medications are hugh. As you get older, you are greater risk for MI or Stroke and many other things. So, the bean counters for these insurance company's see the writing on the wall and let us have the surgeries. Aetna just starting approving the sleeve about two weeks before I had mine. Good Luck.