Medically necessary comorbidities

I am in the beginning stages of having the DS surgery. I called my insurance company as I have Medicare and Medicaid and both stated that if considered medically necessary surgery is approved with a pre-authorization form and Medicare said you must have one or more comorbidities. Medicaid said you just have to deemed medically necessary to have surgery covered

My question is I was told I have chronic hypertension and found out I was pregnant. My surgeon office knows I am pregnant and I do take blood pressure medication for my hypertension. I was wondering will they be able to consider this as a comorbidities since this occured before pregnancy approx 2-3 months before pregnancy? I wasn't put on blood pressure medication until I got pregnant they were worried it'd turn into preeclampsia or eclampsia.

Is this able to be used to deem medically necessary? Since I have a blood pressure medication prescribed to .me. thanks y'all.

I think it will. I had slight hypertension, and didn't need medication for it as long as it didn't go higher. They approved that as a comorbidity. ( I had Fidelis under medicaid )

I wish you the best of luck.

Okay thank you! What all did you have to show that you had hypertension? Did your surgeon document it? Or did you get it from your PCP? Medicaid said I don't need to do the six month medically supervised diet but that I needed a pre-authorization form. Do you know what that is or did you have to have one? How long did it take you to get approved once submitting to insurance.

Sorry for all the questions but I am wondering lol

My PCP did. About the pre-authorized form, I'm not sure what that is. My Mom is a PA, and I did my six months supervised diet through her. It took me about two weeks from submitting to the insurance, until I got approved; six months from start to finish. I'm not sure if I did need the six months cuz I'm still a minor, ( I'm turning 18 in 1 month)?

no problem! feel free to ask anything!

PS: Doing this surgery was the best decision I ever made. The beginning is hard, but it all pays off. I'm less then 6 months out, have already lost 72lbs, and gotten control of my life.

I peeked at your profile, and, given your bmi, I doubt Medicare will require any comorbidities to qualify for the DS. But of course I would make sure your surgeon documents your hypertension and need for medications, just in case.

Also sending you a pm, so look out for it.

Larra

I had already called Medicare. I have the United healthcare dual complete plan and discussed it with them. When I asked them if it depends on BMI. I was told no that they WILL NOT cover Bariatric Surgery unless you have a BMI of 35 and one or more comorbidities, and was told that was specific to my own personal plan benefits. Because I thought the same thing, maybe I will be blessed and they won't need any comorbidities to approve it but from what they told me they do.