PCOS and WLS???
All criteria listed below must be met:
1. Be between the ages of 21 to 64 for coverage of Roux-en-Y surgery and between the ages of 18 to 64 for laparoscopic adjustable gastric banding surgery. Members covered by Medicare should check with Medicare for coverage.
2. Have not had any type of bariatric surgery within the last 10 years.
3. Be morbidly obese with a body mass index (BMI) of 40 or greater.
4. Be diagnosed with one of the following diseases: diabetes, hypertension, high cholesterol (hyperlipidemia or dyslipidemia), sleep apnea, Pickwickian syndrome or Pseudotumor Cerebri.
5. Have evidence of previously failed attempts at losing weight.
6. Have a psychological evaluation that indicates a strong readiness for change and absence of mental disorders that could impact the success of the surgery.
7. Work with a case manager during the entire process and comply with all requirements before surgery and for two years after surgery.
8. Enroll in and pay for the Accomplish program, and lose 5 percent of your verified program entrance weight within six months of acceptance to the bariatric surgery program.
9. Not have medical conditions that would increase the risk of surgical mortality (death) or morbidity (complications) including but not limited to the following conditions: unstable coronary artery disease, severe pulmonary disease, portal hypertension with gastric or intestinal varices, or other conditions thought to seriously compromise anesthesia or wound healing.
Also, ensure you call your insurance company and ask them specifically what the criteria is, each ins company is different. Mine only required BMI of 40 and up OR 35+ with co-morbidity.
I qualified with the bmi alone.