co-morbidities

jobelle · February 19, 2006

Hi everybody???I haven't posted in a while but have a question now. I was scheduled for consult w/Dr. Spivak(Houston), it's a 14 hr drive for me, so I called the day before to ask if they saw anything in my paper work that might be a problem for denial w/ins..(UHC-100% w/pre-d approval). My BMI is acceptable(low end). I am on bp med, borderline diabetes, GERD med, cholesterol med, tx for anx/depression...pcp documented joint/muscle aches and pains, slight swelling in one leg. (I feel like a basket case)

I was told that I needed 2 co-morbidities for which I was taking meds. That to be on diabetic med, along with bp med would get the approval.

Since it's such a long drive, I cancelled. My pcp said I should have went anyway, that most of these surgeons have ways around the co-morbidity issue.

Does this sound like the norm? Or does anyone know what the chance of approval would be, with only 1 co-morb??? Thanks!!!

Mvpo8961 · February 19, 2006

You have Hypertension and Hyperlipidemia for which you take meds. That is two comorbidities right there. That should be basis enough for a consultation with the surgeon. M

MR. BIG · March 2, 2006

Hi, I Would Just Like To Say That The Sooner You Get Your Paperwork In To The Insurance Company The Sooner They Will Send You Back Paperwork On What They Really Want. All That I'm Saying Is That Don't Delay,could Be A Long Road.

jobelle · March 3, 2006

Thanks for input. I'm scheduled for my consult on 3/17. I suppose my paperwork will get started then? and go from there.....

Mona · March 3, 2006

Hey there! Just read your post and thought I'd give some input too. I'm from east tennessee and I have blue cross blue shield insurance. As far as my experience goes, co-morbidities do help your cause but they're not the only thing that insurance companies wanna know about. For example, they also wanna know if you've tried structured, medically based weight loss plans--and failed. And if you've been on a exercise program regularly at least at some point in the past. But in my opinion, if a person is tryin' to have the weight loss surgery then that tells me that they are indeed serious about losing and just need a little extra help. I wish you all the very best on your weight loss journey and many successes. I'm sure you will do great! May God bless you.