Tricare + comorbidities

BekahC79
on 3/30/08 10:07 am - Dundalk, MD
Lap Band on 05/13/13
I was excited Friday to find an email from my insurance company saying they approved the referral to my local wls clinic.  Just to call the clinic and have them tell me that they wouldn't even schedule the consultation for me because my BMI was too low.  And by too low, I mean, I'm just missing it by a few pounds.  But that is for the 35 BMI cutoff w/ comorbidities level.  My questions is, what all is considered a comorbidity?  I know the basic obvious ones like high blood pressure, diabetes, etc.  But I don't have any of those.  I do suffer from depression which seems to get worse the bigger I get.  I also have a lot of back pain and knee pain.  My knees make this weird creaking noise whenever I bend them.  I was told once that the cartilage between my bones might be wearing away.  ???  I don't know if I said that right.  I also occasionally have these awful chest pains that make it hard to breathe.  Nothing in particular seems to trigger it.  But it's always on the left side, and sometimes lasts for an hour or more.  My heart is fine.  I've had it checked.  My last episode was actually at my dr.'s office.  He wouldn't let me leave until it stopped and then sent me for a bunch of blood work that came back fine.  His conclusion was it was some kind of arthritis.  Also, I have a high family history of obesity, high blood pressure, diabetes, and heart disease.  So basically my question is, would these types of things be considered comorbidities?  Thanks for your help!
bonnied
on 4/6/08 1:23 pm - St. Albans, VT
You need to find out your policy's specific criteria. Some insurance comapnies count "severe musculosketal pain" and "GERD--reflux" when many others do not. You might have more than you know, you need your specific criteria. If you do have the criteria and meet it, go back to the surgeon and make sure you weigh enough, even if you have to wear every piece of jewelry you own and 2 sweaters! Unfortunately I havent dealt with an insurer who accepts depression as a comorbid condition yet, it's way too subjective, you cannot accurately measure it like blood pressure. Good luck!
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