insurance question

Hi, Has anyone with State Health Plan been approved for wls with mild sllep apnea and a BMI less than 40.  My bmi is around 42 but in the previous 5 years dropped down to 37. I just found out that I have mild sleep apnea (6 AHI per hour), this is the only major health issue I have other than obesity. Thanks for any info. Tammy

Tammy -

The bmi over 40 should preclude the need for any co-morbidties. The fact that you've had a bmi lower than 40 during the last 5 yrs shouldn't cause a major issue since it has still been relatively high and is currently over 40.

With 6 AHI an hour do you require a CPAP?

Barb

Hi Barbara, I don't think it requires a c-pap but the doctor that I'm seeing said that if I have surgery I would need one because the painkillers would narrow the airways even more.  I haven't even seen my wl surgeon yet.  I went to a seminar and filled out the packet of information and based on my answers regarding my sleep his office ordered a sleep study. After my first sleep study, I found out that I had mild sleep apnea and I just had my second sleep study where they had me to sleep all night with a cpap. I'll find out next week what my results are. I hope insurance pays for all this.  Monday I have my first psych eval.  Is this the usual order of steps before getting insurance approval?  Tammy  

 

 

The order of steps prior to submitting to insurance varies by surgeon and insurance.

First is typically to call the insurance see if they cover the procedure, what are their requiements for approval and which surgeons are innetwork. Then making the appointment with the surgeon... typically many surgeons require you to attend a seminar as well as a nutritional eval and psych eval. As for other pre-op testing that will be up to the surgeon and what medical issues you have. I had no pre-op testing except bloodwork since I was pretty much a 'healthy fat chick'. :-)