PCOS and WLS Approval

As many of you, I also have PCOS with insulin resistance. I am wondering if most insurance companies are considering this to be a co-morbidity. It is a pre-diabetic state and many of us do take Glucophage for it. I am just beginning my quest for WLS (LAP-Band). I have a new patient consult with Dr. Jawad on 7/3. I am also waiting to hear back from Dr. Kim's office as to whether my insurance will allow me to go to them since they are out of network. Let me know your experiences of getting approved through insurance with PCOS. Ali

The insulin resistance is considered diabetes for my insurance purposes...because I was taking Metformin for it. I'm not sure if the insurance considers PCOS a co-morbidity in itself though. Wtih some insurance, you don't have to have ANY co-morbities if your BMI is high enough...though with BMIs in the high range...there usually are those co-morbs to go with it. My approval was simple, though I have Medicare. I had the documented weight loss attempts, the referral from my physician...the recommendation from the surgeon. As far as the co-morbitites go, it was pre-everything. Pre-hypertension, Pre-diabetic, etc. I feel I'm a very lucky one since nothing got full blown before having to have surgery. Sorry I couldn't be of more help, but I do want to wish you success on your journey. I hope that all goes as smooth for you as it did for me. :)

When I was wanting to get insurance to pay for RNY, doc said basically most overweight women have a bit of insulin resistance and pretty much dismissed it..... decided to do cash route (copay for RNY was 50% of a $30k surgery) and did the VSG instead.

Good luck!!! All insurances are different too, so might check your documentation or call them.

For my company it didn't count. I find it sad too that infertility isn't a comorbid. You KNOW if it was men's fertility that was affected, it would be a qualifying factor.

In my case it counted as a co-morbidity. I was/am on metformin and my insurance company saw the surgery was a way to take care of two birds with one stone, so to speak.

In my case it was also counted as a co-morbidity, though I was not on metformin, I was on Actos which worked like a miracle pill for me.   I have Health Alliance Insurance and the PCOS and the high blood pressure were both counted for me.

My insurance ( Tri Care ) does consider the insulin resistance AND the PCOS to be co-morbidity. Along with a long list of others.They basicly told me that any condition you have that is considered "treatable" with WLS, meaning it will get better or go away completly with weight loss, is considered a co-morbidity.  Good luck! Brandi~

My ins. said they BOTH were co-morbidities!! So i got lucky i guess! I hope thigns work out for you!!