PCOS as a comorbidity?

Did anyone successfully use PCOS with insulin resistance as a comorbidity for insurance approval. I have other things as well, but the biggest problem in MY opinion is the PCOS...causing no periods, infertility...more weight gain? Trying to get approved for lapband...and just wondering about other PCOS'ers experience.

I had PCOS with insulin resistance and Hypertension.  When my insurance company accepted me for my RNY it was due to my co-morbitiy of hypertension and the insulin resistance(since I was on medication for it I was considered a diabetic according to the insurance company.  It wasn't because of my PCOS or infertility that I was accepted actually if I hadn't of had the other co-morbitities I would have not been accepted.   Since my RNY my symptoms of my PCOS have significantally decreased along with my blood pressure has normalized and have been off my diabetic medications completely. I do hope that when my wait is up the infertility which I experienced before surgery has cleared up.  Hope this helps. 

I totally understand your feelings.  PCOS and TTC were my biggest motivators for having the surgery, but I was not able to use my PCOS as a comorbidity.   High blood pressure was the only comorbidity that I had, that my insurance company acknowledged when I started the process.  All the others that they accepted - sleep apnea, osteoporosis, diabetes and lymphoedema did not apply to me.  They submitted with HBP and PCOS and I was denied.  However, I continued my nutrition counseling and just knew that I would not stop trying to find a way to have the surgery.  during my 5th month of nutrition counseling, I took a blood test and was considered borderline diabetic.  My PCP and surgeon consulted and decided that I was officially a "diabetic" and re-submitted that day.  I was approved 5 days later.   Good luck to you!   Don't give up!

PCOS was not even condsidered in my getting approval for surgery. Even all I'am like you insulin resistance. I do think PCOS should be one of the ways to get approved. Most women like you said have no peroids, infetitily and overwieght whichs leads to diabetes, sleep apena, high blood pressure, etc. My insurance just passed a new criteria this year-you need to be over 50 BMI and one other thing (though I can't remember). If they hadn't passed that I would proably have to do the 12 months medically supervised weight loss program.  Talk to your dr and see what more you can do to help yourself get approved. I would think they would do everything in their power to help you. Good Luck Brandi I hope you get approved!! Kristin

Thanks everyone for your replies. I'm having the surgery whether they approve me or not, but I'd love to save $15,000. I have sleep apnea...I have a sleep study scheduled on Sunday AND I take metformin for insulin `resistance. I think that's about all of my comorbidities..I have GERD and the other stuff I mentioned, but I don't think those count either. Either I pay $5000 or $15000, but I'm gonna do it and get rid of this PCOS that is making my life HELL.

I listed the PCO but I dont know if it was considered or not in my approval but I had a total of 8 co-morbidities and my approval took 1 week once I got all the info in PCO 620.2 (ICD9 code for medical identification purposes if needed) Morbid Ovbesity 278.01 Edema leg swelling 729.81 Sleep Apnea 780.57 Depression 311 menstral irregularity 626.4 (i added that in case they didnt count the pco) Anemia iron 280.9 back pain 724.5 Hope it helps!

I have the  edema in legs and hands depression menstral irregularities back pain knee pain pcos sleep apnea GERD/acid reflux high cholesterol I hope there is something in there they like.

I just read your post and can understand your frustration in wanting to get the surgery completed whether insurance covers it or not.....but please keep in mind that if insurance doesn't cover your RNY...and you happen to have a complication post op....they also will not cover anything to repair that post op complication.   I was lucky enough that insurance covered my RNY...and if they had not I woul dhave had to pay for the scope tests, surgery to repair my perforated ulcer(6 day hospital stay) and all the meds that went along with them, out of pocket.  Just something to keep in mind.  Good luck on you journey.

I'm having lapband, not RNY. I understand your concern and thanks. Actually, everyone I know that has had it has been self pay, so I'm not to concerned. If it was RNY, as a nurse and seeing the complications that arise from it, I would not venture to persue that process without insurance and a terrific healthcare team close by.

to help your case with the insurance company... get a letter from your OBGYN, endo doc, family doc, etc... get as many letters from all of your docs... and have them list all your issues and that if you don't have this done you will get (fill in the blank)... etc...

I had my OBGYN write one, my asthma doc, and family doc... what helped me the most was the letter from my OBGYN and Asthma doc... my asthma doc is even going to write a letter for me later for breast reduction because smaller boobies will help me breath better lol...

But, I was turned down for lapband but approved for gastric bypass... and my family doc said there are new studies out showing that lap-band doesn't have a lasting effect on PCOS... I have been trying to see if I can find it but so far I haven't and his nurse hates me and won't tell me where to find it lol... so you might want to do some more research into this to see which one would be best for you... because it will also help with fighting the insurance company also... ohhh also a letter from a dietition/nutristionist will help also... even if they don't ask for it...