Proving Comorbidities

Hello!  Like a lot of people on this site, after having four major weight losses and pretty much gaining it back each time, I'm on the path to bariatric surgery (sleeve).  My questions are related to comorbidities.  I know there are a lot of posts on here about them, but I guess I don't see any specific to my particular questions.

I'm above a 40 BMI currently and I won't have surgery due to my six-month physician-supervised weight loss program until mid-March or April of  next year.  I want to continue loosing weight in the meantime and to be blunt, continue to lose without falling under a 35 BMI.  Given my weight loss history, falling under a 40 BMI is very likely.  I want to have the surgery, yet I'm not going to stop trying to lose weight for six months.

The only comorbidity I currently have is hypertension and it's rather recent.  I'm not currently taking blood pressure medication.  Is it enough to prove hypertension simply by a doctor's chart showing I have high blood pressure readings?  If I get put on blood pressure meds, is that alone enough to prove hypertension?  Although I've had high readings here and there probably dating back ten years, I also have a history of normal blood pressure too.  I've even failed my work health insurance screenings three of the last four years due to high readings, but those readings weren't taken at my doctor's office or anything like that.  However, I did show this to my doctor and gave him the screening sheets and he's keeping them in my chart.

I'm also currently taking an at-home sleep apnea test per my doctor and I know a positive test (if I have sleep apnea) should suffice to prove that comorbidity even if it's recent.

So sorry for the long post!  I guess through all my rambling my only big questions are if a doctor's chart showing recent hypertension is enough to prove the comorbidity and if getting put on blood pressure meds (which might actually happen) will be a definite proof of hypertension?  Any feedback would be great!  Thank you!

A doctor needs to enter a diagnosis in your medical record. That's pretty much it. Does the doctor say you have high blood pressure?

Check with your insurance before you go chasing things. Some consider high blood pressure a comorbidity, some don't. Same with high cholesterol. Every insurer recognizes diabetes though.

Plans are all over the place. Get the details for yours.

Thanks Grim Traveller!  Yes, my doctor does say I have high blood pressure now, but he has not put me on meds or anything like that. 

Yes, hypertension is a cormibidity under my plan.  I just need to find out the specifics.  Like these other posts are showing, even though a comorbidity may be covered for surgery, it sounds like there are stipulations all over the place for the comorbidities.  I'm in contact with my insurance company as I should be.  I'm going to try to see if I can pull up the underwriting for my plan online. 

Thanks again!

Check with your insurance about whether you have to stay above 40BMI during your pre-op diet.  Some just require the initial weigh-in at that BMI.  If you lose and go lower, it's okay.

Thanks Emelar!  My plan sounds typical in that I automatically qualify for surgery if I'm above a 40 BMI.  I'll find out for sure, but I'm pretty sure if I fall below 40, that I need at least one comorbidity in order to still qualify for surgery.  That's why I'm asking all of these questions to make sure my comorbidities will actually be accepted for surgery.  I do have hypertension, I just want to make sure it's documented correctly and that I meet the criteria to have it accepted.

Thanks again!

As long as your physician enters a diagnosis of hypertension, you have it and it IS a documented co-morbidity.  It is in your medical record and will qualify you for surgery UNLESS the insurance criteria stipulates you must have hypertension that is controlled by medication and you are not on any.  Sometimes, the criteria states must be uncontrollable hypertension.  However, the only time I have seen that is through Medicaid in a few states.

Thanks Nik_H!  Like I should be, I'm in contact with my insurance company and the woman who handles insurance with the surgeon I plan to go through.  I thought I pulled up the underwriting for my plan on the Anthem BC/BS website, but I think it's just a more detailed description of my plan.  Like you're saying in your reply, there might be some stipulations to qualifying hypertension and I just need to find out for sure what those are.

The first time my Nurse Advocate at Anthem called me, she kept me on the phone for maybe 40 minutes and I hardly did any talking lol, but now I'm having trouble getting her to call me back.  I know it's a process though, and I know I'll find out soon enough.

Thanks again!!

If you lose to under the BMI that qualifies you for insurance the company may still pay or may decide that you are capable of losing weight without surgery.  Insurance companies are happy to save money, not spend it.

I was told to follow the six month diet but not to lose under qualifying BMI.

Each plan has its requirements.  Each request for surgery will be evaluated.  If you are turned down for coverage, you can appeal the decision.  There are lawyers who will take on your appeal case for a fee.  They will advise you on whether your conditions are actionable.

Remember that at least 95% of people who lose weight without surgery gain it back very quickly.

Thank you White Dove!  Yes, that's my biggest concern...my BMI is currently above 40 and I want to continue to try to lose weight in the five/six months before surgery without falling below a 35 BMI, which is the minimum to qualify, but I must have at least one comorbidity to qualify between a 35-40 BMI.

I'm just worried about losing enough weight to stay above a 35 BMI, but then to be denied because a comorbidity wasn't documented correctly or something like that.  Like I should be, I'm in contact with my insurance company and surgeon's office insurance specialist, so I'll eventually get the specifics down lol.

Thanks again!