PCOS or PCOD a co-morbidity? BCBS of AL PPO

Has anyone had Polycystic ovary disease (or syndrome, as it is also known) classified as a serious co-morbidity by BCBS of AL. I am on my second appeal. My BMI is 37, but they haven't considered my PCOS a serious co-morbidity. This time I printed a ton of information off the internet about the positive effects of weight loss on PCOS. PCOS patients gain weight for a reason - as they become insulin resistant. I will keep gaining weight steadily as I have for years, but why should I wait until my BMI is 40. Has any other "lightweights" (haha) had any luck?

Also, I have infertility issues caused by the PCOS (which affects your hormones). I have heard that infertility is considered a co-morbidity. But, is it a SIGNIFICANT co-morbidity?

Kris, According to the NIH Consensus statement: The most prominent condition associated with abdominal obesity is polycystic ovarian syndrome (118), a combination of infertility, menstrual disturbances, hirsutism, abdominal hyperandrogenism, and anovulation. This syndrome is strongly associated with hyperinsulinemia and insulin resistance. (119) (National Institutes of Health) Are you insulin resistant now? How high is your glucose level? Have you been treated with Glucophage? I think you could make a case for yourself, depending on those factors. Fight the good fight! Roberta

I haven't needed to be treated with anything for insulin resistance yet. I was just diagnosed with PCOS a few months ago. I knew that something was wrong for years, but it took going to a "specialist" to finally find out what was wrong. My husband is diabetic, so he has an blood check machine & I check my blood sugar from time to time. It runs on the high end of normal. I get hot flashes when it gets normal/high, so I know to check it then. Diabetes runs in my family, as does ovarian cancer - so, I really hope that they look at that information in my appeal. This is my second appeal to BCBS & they told me that this time it goes to a group of 4 doctors and 2 nurses. I don't know who looked at my first appeal, but it was denied within 24 hours. Thanks for your support. I am not giving up. But, I may have to have a hysterectomy soon. I just can't deal with the symptoms of PCOS. My gynecologist said that WLS would help the symptoms tremendously & told me to try to get the WLS first. She wrote me a good letter to send to the insurance company. I am just so drained from being on my period all the time (months at a time with only a few days in between). My iron levels are low, despite taking supplements and my white blood cell count is up because my body is working so hard to replace blood lost. I hope I hear something soon. I have already had one D & C and it only helped a little. Doesn't the insurance company understand that I could have a myomectomy to remove my uterine fibroids & that would cost as much as the WLS? But, if I lose weight (a lot), they may shrink on their own - to the point that they are bearable. And weight loss would help my andeomyosis (sp?) and PCOS enough that I can put off the hysterectomy and maybe have a child in a few years. I feel like BCBS is tying my hands and not giving me the options that I think I am entitled to.

Don't you DARE give up! Check your plan to see if you have another appeal after the committee meeting level. Many plans have an External Review level, and you have a good chance of approval there. You raised a lot of valid points, especially about the costs. Insurance companies exist to make money and not to take care of your health. A business case analysis showing the costs of each surgery is a good stategy. You could send this in now, before the committee meeting, and ask them to make it an addendum to your appeal. Fight the good fight! Roberta

I won't give up, but I think that BCBS has a strategy of their own. I work for SouthTrust. SouthTrust will merge with Wachovia next month & my insurance policy will change in January. Probably to another BCBS plan, but I'll probably have to resubmit everything. I call BCBS every day & I talk to the same rep every day. She is so nice. She says I can appeal as many times as I want. So, I'll just keep calling & show them how persistent I am. Thank you so much for your support!!!

Kris--I also have PCOS and it got to the point where it was unbearable. My MD put on a medicine to make me stop bleeding and then put me on progesterone and Glucophage. This has helped me tremendously!!! I now have a semi regular period but am a little early at times. (4-5 days early). Please do not give up the fight. I am also fighting BCBS of AL to approve my DS. Keep in touch.