Joint replacement/ Osteoarthritis/37 BMI

[TexasMommy80 297]

I had my first phone appointment today and my patient advocate was great. He did warn me though that Cigna does not list joint replacement/joint disease as a comorbidity to qualify at a lower BMI, but they do list “other”, so it may be one that they accept. I found a document online where they specifically list joint replacement/joint disease as qualifying, but it’s not the document that the clinic has in regards to Cigna qualifications.

Anyhow, he recommended still going through the process, but warned there is a small chance that it could be denied. We won’t know until they send in the final approval. He also mentioned though that they have very high approval rates and will diligently work to get the surgery approved with the qualification of joint disease with the lower BMI.

Has anyone else been in this situation?

[Lotte22 37]

Hi. I have BCBS and 34.8 BMI. My only comorbidity is joint related. I need a total hip replacement. My orthopedic surgeon wrote a note stating that losing weight would be beneficial to my hip and could prolong my hip replacement. I was approved! Good luck to you.

[TexasMommy80 297]

Good idea! I know I have arthritis in my “good” knee too, so between the two, this surgery would help a lot. Not to mention, I need my TKR to last as long as possible because I am only 37 and you should only have two in a lifetime.

[Apple203 1,314]

Any chance you have sleep apnea?? It seems to be pretty common with overweight people and is a listed comorbidity. Check your neck measurement -- over 18" is correlated.

[Lotte22 37]

I’m 38, so I’m in the same boat of needing to postpone my THR as long as possible. With a letter from ortho you should be fine. They even rounded my BMI up for approval.

[TexasMommy80 297]

Any chance you have sleep apnea?? It seems to be pretty common with overweight people and is a listed comorbidity. Check your neck measurement -- over 18" is correlated.

Definitely no sleep apnea, in fact I am super healthy except for severe osteoarthritis.