Co-morbidities

[chocolate_macchiato 23]

...okay, I worry about everything. That's just who I am. Today it's I hope my comorbidities are severe enough for insurance to qualify me. My Stats: 5' 3" 211lbs, BMI 38, c/m high cholesterol, hypertensive and arthritis. Anyone else wanna share?

[Annie B 89]

I think if you're being treated for hypertension you should be okay.

[chocolate_macchiato 23]

Annie you're gonna love this. My PCP never mentioned to not a single time that my NO was even elevated let alone that I am hypertensive. My surgeon brought it to my attention. Even after I went to the doctor after seeing the surgeon did he bother addressing it trying to treat it.

[Annie B 89]

Wow - not good!

[Delta girl 19]

Hi- I'm 5'4 205. My co- morbidities are hypertension and sleep apnea. I've had hypertension for over 10 years. My surgeon referred me for a sleep study just to see if I had sleep apnea and I did. I think it helped with insurance approval.

[Ballermom 803]

Got denied today. The insurance coordinator submitted my info with the diagnosis of "obesity". My bmi is 42.8. Which is morbid. Obesity. So it sounds like that must be the diagnosis. But BCBS il , is even saying that my policy excluded it. Now I'm getting the run around. I have called my Hr etc. but the diagnosis I think is the problem. I have osteoarthritis and Migraine headache.

[geno5150 168]

Got denied today. The insurance coordinator submitted my info with the diagnosis of "obesity". My bmi is 42.8. Which is morbid. Obesity. So it sounds like that must be the diagnosis. But BCBS il , is even saying that my policy excluded it. Now I'm getting the run around. I have called my Hr etc. but the diagnosis I think is the problem. I have osteoarthritis and Migraine headache.

That doesn't sound right. Obesity in and of itself is not a comorbidity. The BCBS-IL medical policy states:

BMI equal to or greater than 35kg/meters² with at least two (2) of the following comorbid conditions related to obesity that have not responded to maximum medical management and that are generally expected to be reversed or improved by bariatric treatment:

• Hypertension, OR
  
• Dyslipidemia, OR
  
• Diabetes mellitus, OR
  
• Coronary heart disease, OR
  
• sleep apnea, OR
  
• Osteoarthritis
  

If you have a BMI of over 35 you also need two of the above list. If you BMI is over 40, then you shouldn't need any co-morbidities. I would call BCBS and ask them why you were denied- don't wait for the doctor's office to do it.

[Ballermom 803]

Thanks for the support.

Because man am I frustrated. I been in this program for 7 months. With all the things I have endured this is stuff!

But I have to be strong and keep trying.

I mean my coordinator has not called me back. But I'll call the insurance again.

[geno5150 168]

Just ask them what information they have and what they still need in order to approve. It's most likely an honest mistake or some missing paperwork.

[Ballermom 803]

Well

I Am Approved yea!

It took 3hours of run around and about several phone calls!

Thank you all

[Ballermom 803]

Just ask them what information they have and what they still need in order to approve. It's most likely an honest mistake or some missing paperwork.

I especially Thank you for literally walking me through this.

Okay the Supervisor of Bcbs suddenly said I am Approved after I ask for her boss.

I wasn't mean but persistent

Yay! Hooray .

[geno5150 168]

I especially Thank you for literally walking me through this.

Okay the Supervisor of Bcbs suddenly said I am Approved after I ask for her boss.

I wasn't mean but persistent

Yay! Hooray .

You're quite welcome. You can also ask them to fax the approval to the doctor so you can get moving on scheduling the surgery. This will save time waiting for the post office to deliver the letter.

Don't fear your insurance company. You are paying the bill, so don't be afraid to ask questions. Each one has a medical policy that defines what is and is not covered and how to qualify- it's not secret information. As long as your company has not excluded it, you should be good to go in most cases.