Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

My name is Jessica, and I am planning on having the sleeve done by Dr Chua in Milwaukee WI. My first visit with the surgeon was in July, but couldn't get started with the nutritionist until early September. I have now had 4 nutrition visits with the follow ups with GP. My BMI is 54, and my insurance requires a co morbidity.... However, I don't have one of the major ones.... Insurance also denied a sleep study because I don't meet all of the criteria. Somewhat frustrated and unsure if insurance will approve surgery. In the meantime I have lost 15 lbs since I saw the surgeon.

Share this post


Link to post
Share on other sites

Good morning. What insurance do you have? I thought that usually insurance will require a co morbidity if your BMI is under a certain number like 40 (mine does). Check to make sure that's the case because I thought the same thing.

Good luck on your journey and congrats on your loss thus far!

Edited by laurenella82

Share this post


Link to post
Share on other sites

I have Molina healthcare (obamacare) in WI

Share this post


Link to post
Share on other sites

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery. The list is from the National Istitute of Health, a government agency www.nih.gov. Maybe this will help if your insurance is really pushing for co-morbidities. Mine (BCBS Federal Employee) only required co-morbids if the BMI is under 40.

  • Family history of heart disease
  • Family history of stroke
  • Family history of diabetes
  • Family history of heart attacks
  • Hyperinsulinemia
  • Diabetes
  • High blood pressure
  • Coronary-artery disease
  • Hypertension
  • Migraines or headaches directly related to obesity or cranial hypertension
  • Congestive heart failure
  • Neoplasia
  • Dyslipidemia
  • Anemia
  • Gallbladder disease
  • Osteoarthritis
  • Degenerative arthritis
  • Degenerative disc
  • Degenerative joint disease
  • Recommended joint replacement from specialist
  • Accelerated degenerative joint disease
  • Asthma
  • Repeated pneumonia
  • Repeated pleurisy
  • Repeated bronchitis
  • Lung restriction
  • Gastroesophageal reflex (GERD)
  • Excess facial & body hair (Hirsutism)
  • Rashes
  • Chronic skin infections
  • Excess sweating
  • Frequent yeast infections
  • Urinary stress incontinence
  • Menstrual irregularity
  • Hormonal abnormalities
  • Polycystic ovaries
  • Infertility
  • Carcinoma (breast, colon, uterine cancer)
  • sleep apnea
  • Pseudotumor cerebri
  • Depression
  • Psychological/sexual dysfunction
  • Social discrimination
  • Premature death in the immediate family

Share this post


Link to post
Share on other sites

Thank you for that information about the co morbidities. I will also discuss these with my Dr. So that the ones I experience are documented. This has been very helpful.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×