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Pseudotumor cerebri, has anyone been approved for surgery for having this?



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I'm currently at a BMI of 35.7 and I have pseudotumor cerebri which is believed to be highly affected by excess weight. Has anyone been able to get approval using this rare disease as a comorbidity? FYI I also have asthma, sleep apnea, swelling feet, and I'm on metoprolol for fast HR.

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

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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.

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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

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5 hours ago, Kary B said:

I'm currently at a BMI of 35.7 and I have pseudotumor cerebri which is believed to be highly affected by excess weight. Has anyone been able to get approval using this rare disease as a comorbidity? FYI I also have asthma, sleep apnea, swelling feet, and I'm on metoprolol for fast HR.

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!

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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.

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13 hours ago, Kary B said:

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.

I used to be on 250mg of Diamox 2x daily. The side effects were terrible- tingling in hands and feet, and extreeeeeeme fatigue. It was the only thing that helped my headaches though. I suffered through the side effects. I had a swollen optic nerve and the docs were fearful of blindness. I didn't have a choice but to take the meds, I did not want to go blind. Diamox is not an end all. I also have Hashimotos diseas and PCOS which makes losing weight at a snail's pace. I hope you can sort everything out and get approved.

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On 11/6/2017 at 9:21 PM, Kary B said:

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.

Hi,

How's it going? Any news on your approval?

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@ Katy B, just wondering what the next developments in your story were.

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