Comorbidities!

I'm almost done with the process, except BCBSNC would not approve an upper gi without me seeing a GI doctor first.  Now my PCP bloodwork came back with some issues...very high testosterone, very low Vitamin D (12!!!), high parathyroid, and elevated liver functions.  My doctor has now referred me to an endocrinologist which cannot see me until 7/11...I'll be done with the upper gi well before that date.  Should I go ahead and get everything to my doctor, see if BCBSNC will approve it, and then try to see if they can schedule the surgery for mid-July (after I see the endo.)???  With my vitamin D that low, would they even do the surgery???  Also, my BMI has only been over 40 for two years so I have to rely on my comorbidities to get me through...I don't have high cholesterol or hypertension or diabetes, so I'm very nervous...Here is what I do have: exacerbation of asthma from morbid obesity, hypertriglyceridemia, stress incontinence, PCOS, GERD, and last night I had a sleep study that suggested hypoventilation (many eposides of very shallow breating).  I know only the insurance company can say if this is enough...but in your experience, are these worthy comorbidities?  Also, if I'm already struggling with vitamin D deficiency, should I seriously consider the lapbad instead of RNY?  I REALLY wanted teh RNY, but would I be doing myself more harm than good?

i had bcbsnc and they would not cover lapband. i had no comorbidities. You just have to have a record of being at least 100 lbs over weight for 5 years. They coverd mine.

My plan doesn't say any of that...it's teacher BC.  The corporate policy says they do cover lapbad and RNY...but you have to have a BMI greater than 35 for the last 4 out of 5 years with comorbidities...If your BMI is greater than 40 for the last 4 out of 5 then you don't need any comorbidities....maybe different policies.

In response to the above BCBS does now cover lapband - they started covering it in 2007. I would talk to the surgeon and find out if they feel you should submit to BCBSNC... I am not sure how a low vitamin D would effect anything but I believe its an easy one to get back up to normal. I wouldnt consider one low vitamin D test as 'struggling'... if its something you can easily control thru diet/supps I wouldnt worry too much - just wait and see what the dr says. Most obese patients have elevated liver functions - most of the time its called 'fatty liver'... its really nothing to worry about and something that should improve with weightloss.  I think you are fine with the co-morbs... I had bcbs and had barely any co-morbs and low BMI - I did have to go thru the appeals process but got my approval.

Unfortunately, I had to delete this post due to privacy concerns.

I'm talking about the barium swallow...my insurance company said that because my doctor has no documentation that I've had reflux for 3 months, they will not cover it unless ordered by a specialist...weird huh?

The funny thing is that most of us probably have low Vitamin D levels.  They were talking about that on Good Morning America a few days ago.  The health contributor said that people do not spend enough time outside for our bodies to make the vitamin for us.   I thik that if your issues were severe enough for you NOT to have the RNY that your doctor would certainly let you know.  Like Jenn said..  some of what you mentioned wiill improve with your weight loss.   I have BCBS State Employees and did not have one comorbidity...  if your BMI is over 40 you dont have to have comorbs to qualify for the surgeyr. Keep us posted!

 

My opinion is I did the right thing for myself with RNY yes it was a hard choice to make but it is turning out to be the best thing I ever did. As far as problems from RNY I have never thrown up after eatting unless I made myself if I had something stuck not a good feeling. My srgeon required to have a Vena Cava filter put in bf surgery and mine saved my life. My filter caught a large clot so the filter did what it was suposse to do. Not everyone needs a filter but in my case I am grateful I had one My husband and I were just talking to my mother and she heard on one of her news shows someone predicted gas going to 15 dollars in the future. I told hubby thank god for my pouch. If this happens we were taking about how much food would be so once again I say Thank God For My Pouch.                                              Annie

i wish i had an answer for you. i havent even went to my first pre-op appt yet. all of them are scheduled within the next month. my BMI has went over 40 only once. i have been on an average at 35. im currently 39.2. i have no diagnosed comorbities BUT i think i have stress incontinence and sleep apnea issues. im hoping in your case, as well as mine.. BCBS sees that we NEED this surgery(tool) to help us get healthier and stay that way. obviously if we could do it alone , we wouldnt be here take care