Co-Morbid Insurance Question

[HotMama24 0]

Is PCOS considered a co-morbid condition? My insurance will cover the LAP-BAND® surgery 100% if I have a BMI over 40, or 35 with a co-morbid condition. I have PCOS and my BMI is 35.4.

Does anyone have any experience with this? I have United Health Care.

[Band_Groupie 3]

I don't have the same insurance and even within mine (BCBS) the rules are different from different areas. Mine was very specific on everything except the 'comorbidities' as they just gave a few examples (ask for a copy of yours if you haven't yet). From some detective work I found out that mine will only approve you (I'm also under 40 BMI) if you have one of the 'biggies' which are hypertension (high blood pressure, high cholesterol (some insurances have certain no's. they're looking for even), heart problems caused by obesity, diabetes, and sleep apnea. All of these have to be diagnosed and have documented treatment by a Dr. (ie. you have to be on medication for high blood pressure). The rest of the comorbidities help to add to your case, but won't get you approved...for my insurance at least. A good place to start is with your PCP and getting blood work done...you may have one of these and not even know it. Good luck!

[HotMama24 0]

Thanks so much for the information. I acutally have blood work done regularly with my Endocronoligist, I am insulin resistant (due to the PCOS) but I'm not diabetic, and I have an irregular heartbeat with trace leakage, but nothing I have to take meds for. My cholesterol is great too... BOOO lol, hopefully I can still get it approved!

[RestlessMonkey 7]

Check with your insurance to find out exactly what "they" consider co-morbiditiy. However I don't think I've ever read of any company considering PCOS a co-morbidity. Maybe? but i doubt it.