Wife's WLS drama

Hey everybody. I hope some of you ladies can shed some light on this for us. My wife has started the process of WLS with Dr Bauman. her BMI is 38.7 or so. She has several co-morbidities, but not HTN or Cholesterol. We looked at the list of co-morbidities that I found a link to on a lady's blog through this site. She has irregular periods treated by her OB/GYN, depression, and some of the others listed. Dr Bauman has requested a sleep study since her BMI is below forty. She snores most nights and does have periods of apnea, but she doesn't do it every night. If the sleep study doesn't show apnea, what are the chances that she will still be approved with BCBS? Thanks in advance. Brian

That's hard to predict, Brian.  I think you will just have to trust Dr Bauman and trust the process.  I don't mean to sound trite or non supportive, but I am confident that Dr Bauman knows how to approach the insurance company with just the right amount and kind of documentation.  It'll be ok, Brian.

Hi Brian, The so called list of co morbiditys for obese people can get pretty long. You have already mentioned depression,irregular periods, and snoring. I have heard if you snore you probally have sleep apnea. Keep in mind the doctor wants to make a living by helping people like your wife so he will document what he needs to so the insurance will pay for her surgery. Good luck to you both.                                       Annie

Thanks for your replies. We both have a lot of trust and faith in Dr Bauman and his fantastic staff. They were able to get me approved with only 3 years of weight history and a letter from my Medical Director rather than my PCP since I don't go to the dr on a regular basis. I have lost 130 pounds with his help, and my wife is at the end of her rope. She has tried everything from Weigh****chers to Nutrisystem with little or limited results. I was just hoping to get some encouraging words for her. Thanks again. Brian

Brian, sounds like you are very encouraging and helpful to your wife. I dont think I could have gone through my wls without the love and suporrt of my husband. Tell her you are her best cheerleader. She will always love you for sticking with her through this journey.                                            Annie

I had a low BMI, no sleep apena and none of BCBS's listed comorbs... I didnt meet their 'basic requirements' but went thru the appeals process and won on final appeal - basically with insurance its a craps shoot but thats why there is an appeals process.

Brian,

Co-morbidities are things that can kill you, like sleep apnea, high cholesterol, high blood pressure, diabetes, etc... While irregular periods and depression can affect the quality of life, they aren't considered a co-morbidity. As the others that have posted before me have mentioned, your Dr. will help you with the process.

Wishing you all the best,

Barb

Barbara, While  I agree that those can't kill her they are still medically considered co-morbid factors when dealing with Morbid Obesity. Being a co-morbidity does not mean that it alone can kill you. It is simply a contributing factor to the overall picture of health. Thanks for your concern. I don't mean to sound ungrateful for your advice. I just want to be clear that we fully understand the terminology and factors associated with this condition. Thanks again.

Brian,

I apologize, I misspoke. You are right, comorbidities are indeed medical conditions that exist alongside as the primary condition in the same patient and will not necessarily lead to a person's demise. It is my understanding that insurance companies do not weigh all comorbidities equally and just because a condition may be a technically comorbid condition, it may not be a comorbid condition that the insurer will recognize as one that support a determination that WLS is a benefit that they will cover. I hope that your wife meets the comorbidity requirements recognized by her insurer necessary to attain the WLS she is seeking.

Thanks for correcting my mistake.

Wishing you and your wife all the best in her journey,

Barb