Kary B

Thank you all for responding to my question! Today is my first day on the forum. I am very nervous about not being able to get approval. I tried oral meds to control my pseudotumor but i discontinued treatment due to the severe side effects. I was also on a medically supervised diet but my Dr discontinued treatment due to my elevated HR. Hoping my medical records will be sufficient to cover the 6 month diet required by BCBS IL.

Welcome and bless your heart! Sorry you're dealing with so much!!! I've no experience to offer, only hugs.

Generally sleep apnea is considered a comorbidity. My insurance policy reads
Surgical treatment of obesity (bariatric surgery) is covered only if:
- eligible enrollee is 18 of age or over- clinical records support a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity). Applicable co-morbid conditions include the following:
• T ype II diabetes mellitus (by American Diabetes Association diagnostic criteria).
• Refractory hypertension (defined as blood pressure of 140 mmHg systolic and or 90 mmHg diastolic) despite medical treatment with maximal dose of three antihypertensive medications.
• Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications).
• Obesity–induced cardiomyopathy.
• Clinically significant obstructive sleep apnea.
• Severe arthropathy of the spine and or weight bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for obesity).
- Documentation of failure to lower the body mass index within the last 12 months through a medically supervised program of diet and exercise of at least 6 months duration.

I have pseudotumor cerebri also. My BMI qualified me, but I would suggest having your neurologist write a letter of support so your surgeons office could submit that along with other qualifying documents.
Good luck!

Hi there,
I also have IIH (pseudo tumor) and I'm having VSG as my mode of treatment instead of brain surgery (shunt) I however started with a BMI that qualified for surgery either way. I would suggest getting your neurologist on board and providing your insurance company with a statement. Hope that helps.
Peace and love

I also have BCBS of Ill. I was approved. My BMI was just over 35 and I have several co-morbidities, including sleep apnea and have had a heart attack.
Requirements were one appointment with Dietitian, session with Surgeon, and psych evaluation. I believe this varies company by company (or by your group) so you'll want to talk to the insurance company directly to find out specifically what applies to your plan.
Once everything was submitted, the approval came in just a few days.
Good luck!