Question:
Detailed List of co morbidities
I don't suffer from high blood pressure, diabetes, rashes, high cholesterol, arthritis, or any comorbidities that I frequently read about. My BMI is 44, but my physician says I will have a battle with ANY insurance company to pay for WLS. Does anyone have a detailed list of accepted comorbidities that I might refer to?? Thanks very much! I guess I should be grateful I don't have any of those illnesses, but it's a bit of a double edged sword too. — NicoleG (posted on January 23, 2002)
January 23, 2002
I don't know where your doctor is getting his information, but he's wrong.
Look at all the people on this site who have had this surgery. Insurance
has paid for most of them. Also, for the most part, the surgery is
recommended for anyone with a BMI over 40, or a BMI over 35 with
co-morbidities. If your insurance pays for the surgery at all, I'm sure
you'd qualify.
— garw
January 23, 2002
Theoretically, if you have a BMI of 44 or higher you don't need any
comorbidities. From my experience and other posters it seems that it is a
lot tougher battle to get insurance approval. Do you have any back, hip,
knee or foot pain? Are you limited in your activities at all by being
morbidly obese. Those are actually considered as comorbidities, and I would
be surprised if at 44 BMI you didn't have at least some problem like that.
— Dell H.
January 23, 2002
Here's my list, but the main thing is that this is a preventive surgery to
keep you from getting all this stuff in the future, as it may be lurking
around the corner: Oops, the just went to get my journal off the kitchen
table and realized it's in the car. I'll get back with you after work
tonite. My family doctor highly encouraged the WLS because he said if I
didn't do something, I would be a real health risk. I'll get back at ya
tonite after work.
— Annie H.
January 24, 2002
I don't have an answer. I just have the same problem. I am 25 YOA, my BMI
is 47. I have no diabetes, or high blood pressure, or sleep apnea, etc.
And your doctor is not wrong. It depends on your insurance policy, not
your insurance company. There is a whole bunch of people who do not have
an exclusion clause on their policy. So do not have a problem getting
approved if they have no comorbidities. If your policy has an exclusion
that says "must be medically necessary", than you DO have to
prove that it is medically necessary. It doesn't matter if it is preventive
for future health problems. It depends on your policy. Some policies have
a solid exclusion where they don't cover it at all even if your dying. YOu
have to look at the words that your policy states.
— [Anonymous]
January 24, 2002
I had a BMI of 44. 5'4, 261 lbs. I didn't have any battle. In fact, I
was approved within 48 hours. My co-morbities were small - acid reflux,
high cholesterol, joint pain (knees). I asked about co-morbities a few
months ago. Check the library. I got some great detailed lists.
— Goldilauxx B.
January 27, 2002
Ok, after many hours in frint of the computer, I did stumble across a
couple of things that may count as comobidities! Correct me if I'm
strtching here.
1) Acanthosis Nigricans - per my mother, have had this skin discoloration
on the back of my neck since early puberty, I started menses at age 8
2) Activity Intolerance secondary to obesity. In a nutshell, after I move
aroud a bit, I become winded.
3)Depression related to morbid obesity.
I have Tricare Prime and know they do pay for WLS. After corresponding
with a long post op who had her wls paid for by Tricare, I'm feeling
hopeful! According to her, no comorbidities are necessary if BMI is greater
than 44. The only problem with that is this. Could you imagine someone with
a BM! of 40 GAINING weight just to qualify for her insurace company to
cover it?
— NicoleG
July 3, 2002
well i myself have kaiser ins. they said i was coverd for either MGB - RNY
- Lap - Open if i have a doctors ok. So well I'm seeing him on the 31st of
july I'll keep you posted
i only have a bmi of 38- 39 im 5.2 and weigh in at 213 with alot of co
morbities still have to prove some others i dont have to prove its in my
records but here anyway i'll list them. I have
x) depression
x) rashes
x) arthritis
x) Activity Intolerance secondary to obesity. In a nutshell, after I move
aroud a bit, I become winded, or wounded.
x) sleep apnea
x) irregular periods
x) swelling & stiffness in your ankles and legs, hands arms
x) joint pain knees and back
x) High blood pressure
x) diabetes while i was pregnant
x) and i dont know if this counts but it should uncontroled urinary
movement with coughing i literaly have to wear think pads 7 days a week
31 days a month to protect my pants
x) frequent reacurring brocitis
and if you go to my page I wrote a letter to my doc and pasted it on my
profile to share I'm taking it with me on the 31st any more help, or
suggestions for me or ??'s email me at [email protected]
— Tina R.
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