Is PCOS considered a co-morbidity?

[GOTIGERS 2]

I just went to my first seminar and got all of my paperwork turned in to get this process rolling today. The surgeon who did the seminar mentioned poly cystic ovarian syndrome while discussing co-morbidities. My insurance paperwork did not have anything on there about pcos. Are any of you familiar with this? Did your insurance consider pcos a co-morbidity? I am not full blown diabetic, and I do not always have high blood pressure. Although the medications I take for pcos control both blood pressure and regulate blood sugar. I'd love to hear any input ya'll might have about this. Today started my journey, and I truly appreciate all of the advice I can get along the way.

Thank you

[beautysleeve559 69]

I personally don't have pcos, but I have read other people's topics that have it and they say the insurance considers it a co-morbidity

[KristenVSG2014 1,871]

I have PCOS and was diagnosed as diabetic four years ago but then I lost 70 pounds and was able to reverse the diabetes. Unfortunately after a long stall I ended up gaining back 40 pounds. Now I'm back at 100 pounds overweight. Despite my LONG history of PCOS, diabetes (although reversed) and high blood pressure on appetite suppressants, my insurance refuses to cover any type of weight loss surgery. It blows my mind. They would rather me become diabetic again and spend thousands of dollars with complications from my weight down the road than cover a simple one-time procedure. I really hate insurance companies.

So I got a loan and I'm going to Mexico and praying for no complications.

Kristen

[KristenVSG2014 1,871]

To answer your question, my insurance company does not consider PCOS a co-morbidity. :-(

[KristenVSG2014 1,871]

They also refused to cover my Mirena IUD for endometriosis. I had a letter from my doctor explaining it was medical necessity and not needed to contraceptive purposes. Nope. Shot down. So I paid $1,000 for it. Best purchase ever! I'm hoping I will feel the same about my gastric sleeve surgery!!

[a_new_me_finally 2]

I am in the beginning stages as well and when they were asking me if I had any "weight-related illnesses" I mentioned PCOS, and they attributed that to my weight (which my GYN did as well) and they said I qualified for the surgery. I hope that helps! I have Aetna and BCBS is my secondary. Hope that helps & good luck on your journey !!

[finediva 979]

They also refused to cover my Mirena IUD for endometriosis. I had a letter from my doctor explaining it was medical necessity and not needed to contraceptive purposes. Nope. Shot down. So I paid $1,000 for it. Best purchase ever! I'm hoping I will feel the same about my gastric sleeve surgery!!

Well my goodness, what do they cover? Smh

[KristenVSG2014 1,871]

Well my goodness, what do they cover? Smh

Lol, only basic routine checkups, bloodwork and medication. The sad thing is it's through my employer. Thankfully, Mexico is an option.

[KattattaK 45]

Yep! My pcos along with my insulin resistance is what got my lap band wls approved in 2005. Still have the band but it developed a leak in 2008 and it hasn't been filled since 2009.

[GOTIGERS 2]

Which insurance did you have krisrpaz? I'm sorry to hear that you had so much trouble getting it covered

[KristenVSG2014 1,871]

Which insurance did you have krisrpaz? I'm sorry to hear that you had so much trouble getting it covered

BCBS of Florida

[GOTIGERS 2]

I'm so surprised that insurance companies don't just jump at the opportunity to approve weight loss surgery. I mean, I'm sure it's way more expensive to pay for a life time of medications and specialist visits for a diabetic. I know that with my pcos alone, I have had so many tests and dr's visits, and even a plethora of medications. I'm sure it's way less expensive to them to just cover the dang WLS. I just don't understand it

[mi75 1,235]

Not all insurances consider it, since it is a SYNDROME and therefore, the ICD-9 code for it can be refused by billing as a billable diagnosis...

your only way to know is to call your specific insurance and ask them.