Question about co-morbidities?

[webhopper 57]

Hey; quick question....

My BMI is at 40.3 now; but I haven't even started the diet yet; I go to a seminar on Thursday

My insurance is cigna; and the surgery is covered. If I lose below a 40.3 during the diet phase will my new BMI be used or will the old BMI be used?

Also; is a compression fracture in my spine a comorbidity? Its a 20% compression of the t12 from a fall I had.

What about asthma?

[Chele H 427]

They SHOULD go by your starting weight but I was just barely over a 40 bmi with no co-morbitities and my doctor told me not to lose any weight at all just in case it fell below the 40.

You should call and ask specific questions regarding the bmi requirement, get the person's first and last name and a printed copy of their wls requirments.

Good luck!

[webhopper 57]

I know I'm still really early in the process; and id be willing to even gain weight if needed... I will be asking a lot of questions when I go to the seminar and find out what I need to do. Also; the compression fracture occurred on December 9 and it actually may have shrunk me by an inch which helps. The bone and joint doctor recorded my height as 1 inch shorter than I used in the BMI calculator.

[Bandista 7,466]

I was borderline -- my insurance required a 40 with no exceptions even for high BP or apnea. I let people know along the way that this was a big concern for me and I had to get a little creative at weigh-ins, ahem, but then when I finally met with the surgeon he said, oh we would have let you weigh in with a purse on your shoulder or whatever it took. By then I had gained weight and stressed quite a bit over the whole thing. It did all work out but nice if they can work with you from the get-go.

[DLCoggin 1,788]

My understanding is that your BMI (in the absence of comorbidities) must be 40 or greater at the time your surgeon's office submits the paperwork to your insurance company. Anything you lose after that point is a good thing and once the insurance company approves the surgery, it is illegal for them to rescind it. Not sure about the spine problem being a comorbidity or not but it's an interesting question. Since you said it was from a fall, perhaps not. But then a case might be made that the fall was the result of the obesity. I'd be interested in hearing what your surgeon says when you get to that point.

Welcome to the forum! You're gonna love the new you!!

[taylokat 180]

Most insurance companies consider co-morbidities to be High BP, high cholesterol, diabetes or sleep apnea.

[webhopper 57]

I don't have high BP; diabetes;

I may have sleep apnea but not sure. What constitutes high cholesterol? I'm not on medication for cholesterol but my good cholesterol was way low and my bad cholesterol was way high and the combined number was over 200 last time it was checked...

Also; cant co morbid conditions include structural things like joints and bones as well as asthma? I have asthma which is controlled with an inhaled as needed.

[webhopper 57]

My LDL was over 160 and my HDL was 38. It was kind of opposite of what its supposed to be.

[SuperFab 689]

I don't have high BP; diabetes; I may have sleep apnea but not sure. What constitutes high cholesterol? I'm not on medication for cholesterol but my good cholesterol was way low and my bad cholesterol was way high and the combined number was over 200 last time it was checked... Also; cant co morbid conditions include structural things like joints and bones as well as asthma? I have asthma which is controlled with an inhaled as needed.

Actually SOME insurance policies will take into consideration joint and bone issues. Especially with a letter from your PCP supporting the claim stating that WLS should help take pressure off those areas, etc. unsure about asthma.

[webhopper 57]

Sorry for seeming very dumb but I'm trying to figure out if I have a shot or not even with a BMI less than 40 since my BMI might drop. I haven't been this heavy for a long time and ive always been in fairly decent shape Healthwise other than chronic respiratory issues... now that I'm heavier its hard to excercise and I stay so hungry that I really feel that the surgery will help me stay on track for the future like I need to in order to keep the weight off.

[SuperFab 689]

I'd straight up contact my insurance and ask them. All policies are different. I wish I knew more about what all they require but I know I got all of my questions answered and even when I couldn't understand what they meant I just told them that I didn't understand. Asked if they could explain it to me and they did.

[webhopper 57]

That's a great idea; I did call them to ask and make sure there was coverage and they said yes; so maybe I can ask them to send me some information

[SuperFab 689]

Definitely. Plus they will answer specific questions you have.

[webhopper 57]

For those who are following this; I went to the seminar... found out that I do not need co morbidities to qualify and that the doctors office will go by the weight recorded at the very beginning of the process; so I have been worried for nothing.

My surgeon will be Dr. Ladd Atkins.

He did mention that acid reflux can be worse with the sleeve than the band and that people who have acid reflux may find that it gets worse after getting sleeved. I will probably make a thread to get more insight as to the reflux issue.

I also found that the seminar was very helpful and that Dr. Atkins is very professional and I felt comfortable around him.

Also; even though I will be out of network for my insurance (CIGNA) they will treat me like in network regarding the percentage that I will owe which is a big deal... my husband and I agreed ahead of time that we felt more comfortable going to a specialy surgeon who specializes in this type of surgery rather than going to the in network hospital. The facility is clean and top of the line; I was very impressed by the facility and the quietness on the floor. The hospital is ONLY for Dr Atkins patients and they have only 4 rooms.

Super happy with my experience at the seminar.

[SuperFab 689]

For those who are following this; I went to the seminar... found out that I do not need co morbidities to qualify and that the doctors office will go by the weight recorded at the very beginning of the process; so I have been worried for nothing. My surgeon will be Dr. Ladd Atkins. He did mention that acid reflux can be worse with the sleeve than the band and that people who have acid reflux may find that it gets worse after getting sleeved. I will probably make a thread to get more insight as to the reflux issue. I also found that the seminar was very helpful and that Dr. Atkins is very professional and I felt comfortable around him. Also; even though I will be out of network for my insurance (CIGNA) they will treat me like in network regarding the percentage that I will owe which is a big deal... my husband and I agreed ahead of time that we felt more comfortable going to a specialy surgeon who specializes in this type of surgery rather than going to the in network hospital. The facility is clean and top of the line; I was very impressed by the facility and the quietness on the floor. The hospital is ONLY for Dr Atkins patients and they have only 4 rooms. Super happy with my experience at the seminar.

Yay!!! So very happy for you!!!