questions about insurance requirements

So I had my first appt with my surgeon and have had my first class of six. I was told that I may have problems with my insurance for the following reason.... I have a BMI of 39. I DO have comorbid conditions - hypertension, sleep apnea. However, they told me that my insurance is very particular about the comorbid conditions. For example...with the hypertension, they require that you be on THREE medications. With the sleep apnea, they require that it be a PARTICULAR type (I guess there are different types ). They are requesting the results of my recent sleep study to check that out. I was wondering if anyone has run into this?? How was it handled and how did it turn out???

The only answers to your questions about your insurance will come from your insurance company. Sorry, none of us here will be able to tell you.

Okey dokey.

Different insurances require different hoops to be jumped through. There are different kinds of sleep apnea the one I have is obstructive sleep apnea. When my throat relaxes and sleep it closes. it's a physical thing. Luckily not breathing tends to wake you up...lol. it only happens when I sleep on my back so I sleep on my side. I'm a light sleeper so it's not a big deal for me. I don't accidentally meat end up on my back because I wake up when I turn over...

I don't know much about the other kind of sleep apnea. It might be more like the kind babies have when they're born where the body forgets to breathe. I would suspect the obstructive sleep apnea is the one they're looking for because that would be fixed by losing weight whereas the other would not.

Perhaps you could go to your doctor that treats your hypertension and tell them the problem you're having with your insurance company and they could prescribe you another medication? Or don't tell him what problems you're having with your insurance and just tell him that your medications not quite working for you....can they prescribe you something else? Lol

You need two comorbidity issues, right? Perhaps there's one that you have that you don't know you have? Reflux for instance or GERD?

I didn't realize that the sleepp problem (obstructive sleep apnea)I had was even "a thing"until the doctor asked about it during his pre-op evaluation.

My insurance is surprising relaxed about it's requirements compared to others. Hopefully everything turns out well. I have a question. If your bmi had been higher would they have more relaxed stipulations?

If I was in your situation I would gain a few pounds and achieve the 40 BMI.

Whatever you do, do NOT take their word for it. Find out yourownself with the insurance company. My guess is that you'll slide right in.