What qualifies as a comorbidity?

I just had a consult with Dr. Simpson's office, and was told that this is what my insurance requires:

- 5 years medical records showing BMI of 40 or 35 w/comorbidity
- 9 months supervised diet and physical therapy.

So I decided to go back to my PCP to do the 9 months, (though I really don't know how that's going to work - what do I do, keep a record of everything I eat?).  But here's my question:  my bmi is now over 40, but 5 years ago, it wasn't - it was 35.  So, now I have to come up with a comorbidity - I haven't been really good at getting physical exams, so I don't have any documented comorbidity that I know of, but I will have my doctor check for things on Monday.  What things would qualify as comorbidities?  

It depends on your insurance company.  Some insurance co's have very specific criteria.  For example, one insurance company might require diabetes where you need insulin.  Others are good with diabetes and oral meds.

Only your insurance company can tell you since it's different with each company.

Hi Charlotte180,

 

Another good example of a comorbidities is when a person has a diagnosis of COPD or sleep apnea and they are  treated with oxygen at night when they are sleeping. I use to have sleep apnea before my ERNY in July 2008 and have used oxygen for several years. Since I have lost weight I have passed my sleep studies with flying colors. I just got rid of my oxygen compressor. Plus my daily headaches due to lack of oxygen has gone away too! I am glad that I had my surgery because I feel much better. I wish you good luck when you have your surgery.

It could also include High Cholesterol, High Triglicerides, sleep apnea, hypoxemia, high blood pressure, heart problems, arthritis, degenerative disk disease, asthma.  When you do your letters document every diagnosis you have ever received.  Give them the comlete picture.  Make sure your PCP documents your diet, exercise, pharmacological, behavior modification and make sure you have attended support groups and get proof.  Keep track of everything. 

Hi there,
I am a patient of Dr. Simpson. I read your blog about possibly wanting RNY. Hopefully his office told you that he only does LapBand.  He's terrific and so is all his staff.
Insurance companies have similar but somewhat different requirements and it differs within the same company depending on your plan. I have BCBS of Arizona and they were a bear( to say it politely), but Dr. Simpson's office fought hard for me..it took several months...but once I was approved I could have had surgery in 6 days but it was Christmas so we waited til New Yr's Eve.
Others have already given you lots of examples of co-mormidities.

Good luck in your quest!
Junie

Sorry for a delayed response, but I didn't have the typical co-morbidities such as high blood pressure, high cholesterol etc. 

But what I did have was horrible low back problems, I have chronic lower back problems from degenerative disc disease and my added weight didn't help!  My insurance was paying so much money a year for pain medication, epidurals, physical therapy, etc for many years and they approved me very quickly.
So, things like arthritis, back problems can also be considered a comorbity.

WLS didn't solve my lower back problems... but significantly reduced it.  I am having some pain again, but I think it's from the gym. 

Good Luck!

~Nicole