Documenting co-morbidities, BMI under 40

[daco525 0]

I am really working hard to get all my ducks in a row for an approval in May. I am counting on approval based on medical necessity due to co-morbidities. I take medication daily for diabetes type II, hypertension and high cholesterol. All is controlled and stable with meds. I have also just begun seeing a podiatrist for bone spurs, they are now giving me orthotics and I have a sleep brace. I am also now seeing a gastroentrologist for GERD. This just developed three weeks ago and I had an endoscopy today. I was thinking it would be in my interest to have both of these drs (pod & gastro) also write a note on my behalf to support medical necessity. They may not be co-morbidities but these new medical issues would be greatly helped by weight loss. Has anyone else been this route?

[Band_Groupie 3]

It can't hurt and if you're not sure ask the insurance specialist at your surgeons office. I was on the 'over-kill' route in collecting stuff like this, but found out when talking to my surgeon's ins. sp. that it's not needed for my particular ins. co. (they are the easiest ones she works with), in fact too much info. may delay things; but for others ins. she works with it would be needed. Good luck.

[SuzanneG 1]

I was BMI of 35.1 and denied by BC/BS the first time through. Then I assembled an appeal package, very much like your initial request. I went to all my docs, pediatrist, gastrointerologist, GYN, GP, and asked each for a letter of support. Then I wrote 2 letters of my own and attached them to the package and sent it to the bariatric doctor. By this time my BMI was 36.7 since I figured I would have to eat my way to approval. He submitted the appeal and it was approved.

Best of luck to you. Sounds like you are on the right track.

[Carolina Mom 0]

I am really working hard to get all my ducks in a row for an approval in May. I am counting on approval based on medical necessity due to co-morbidities. I take medication daily for diabetes type II, hypertension and high cholesterol. All is controlled and stable with meds. I have also just begun seeing a podiatrist for bone spurs, they are now giving me orthotics and I have a sleep brace. I am also now seeing a gastroentrologist for GERD. This just developed three weeks ago and I had an endoscopy today. I was thinking it would be in my interest to have both of these drs (pod & gastro) also write a note on my behalf to support medical necessity. They may not be co-morbidities but these new medical issues would be greatly helped by weight loss. Has anyone else been this route?

Hey, I called my insurance first thing to find out what they required. They are there to help you. I think you are on the right track. I have arthritis, fibromyalgia, hypertension, sleep apnea, and after my pre op visit I now have a heart condition that I have to worry about. Call and see what they say your could be spend out when it is not needed.

Good Luck!!!

[PATCHELTON 0]

Not sure if the bone spurs qualify, but if your podiatrist feels they are weight related, a letter from him/her should help. On my insurance (Blue Choice) the list includes diabetes, high blood pressure, high cholesterol, joint arthritis, reflux (GERD), sleep apnea. I had everything but diabetes and my BMI was around 38. Sounds like you have a winner. You never know with the various insurances, but most only require one or more co-morbidity.

[daco525 0]

Thanks for all the info. I think I am headed in the right direction for an approval.

[phenry 0]

What do you all think about borderline hypertension along with my high cholestrol? I had a stress test on Friday and even though my heart checked out fine, the doc said I am borderline with high blood pressure. I too am under a BMI of 40. I think I am about 36.5 or something. I am gathering all my supporting documentation to hopefully get approved through BCBS HMO of Indiana.

[daco525 0]

Are you on any medications. Have your doctor document all these borderline conditions. Do you have any problems with joints (arthritis) or any acid reflux. I have had prolonged problem with my feet and mild acid reflux. Conditions I have lived with and not sought medical attention. Now that I am going through this process I am under a podiatrist and gastro's care. I am going to have them write a letter on my behalf as well. The more support you have the better. I know this sounds terrible but I believe in the long run if the ins company thinks they are saving money by giving you this procedure you have a better chance. If they think you are at risk for "expensive" complications they are more likely to give it to you. Also document any family history of obesity related problems. For example both of my parents had heart attacks in their early 60's. I have some of my parents medical records to verify and when I spoke with my ins co they said this should be documented in the drs. letter. Good Luck.

[phenry 0]

yes, I am on Zocor for the cholestrol and the hypertension was just discovered, so we are taking a dietary approach to see if it controls it. I have plantar fasiitis right now and also GERD. I am getting a letter from the Cardiologist stating my borderline condition. I agree...the more documentation the better. This will be my first attempt with the insurance company and I am really hoping for an approval. I would rather take my time and have over kill than to submit a request that will just be denied! I know what you mean about hoping the insurance co will see that it is better to treat this now than wait until something major happens. I have been overweight ALL my life...this isn't something new. Heck...why don't insurance companies at least agree to pay a percentage if they won't cover it all. That would be okay with me. Of course if they cover the whole procedure it would be nice...but I would rather they help me out some rather than to deny completely!Good luck to you too!

[phenry 0]

I just had a stress test done and although it came out pretty good...my blood pressure got high during the exercise portion. My doctor is wrote me a letter to submit to the insurance company that states I have a history of hyperlipidemia and shortness of breath under exertion. He advised me to watch my weight, reduce salt, exercise and lose weight. He says losing weight from a cardiac standpoint would be very beneficial in reducing my blood pressure. I also have a letter from my primary care physician. Her letter says I am overweight with hyperlipidemia and have shortness of breath on exertion. I also have plantar fascitis, arthritis and have had no success with diet and exercise such as Weight Watchers. I think she would benefit from Lap Band surgery.

SO...I think I have what I need to submit to the insurance. I also have a copy of my food diary from Weight Watchers. The thing I didn't do was get a letter from the foot doctor. Of course If BCBS just looks at my profile and history of doc visits..they should see I have had so many visits from foot problems. Of course I am sure they want you to do all the work so they don't have to do anything! Wish me luck...I will send my packet in to the surgeons office on Monday. If they say it looks good enough to submit...I will have taken my giant step forward.

[daco525 0]

I can't wait to hear how you make out. Best of luck.

[phenry 0]

Thanks! I will certainly keep you informed.

[MiniBand 0]

Yes absolutely have every Dr. you visit document a positive endorsement. Another thing keep a log yourself of your food intake, your exercise and symptoms that go along with your co-morbities.