Severe OSA... getting approved by insurance for WLS...

I'm just wondering if anyone has had any luck getting around an insurance exclusion by claiming that WLS is a treatment for sleep apnea. My sleep study showed that I have severe sleep apnea with a significant drop in blood ox levels. I'm on CPAP now and it's saving my life, but I know I also need WLS to improve my health.

sleep apnea is a comorbestiy..so it should be all good for surgery..the more comorbestiys you have the better it will look for your insurance you could fight them..good luck..

Hi Shana, this is one of the things I based my appeal on. My appeal was denied, but not because of this - it was denied due to them not even reading the appeal because I have the exclusion. So good luck getting them to even read the appeal. I took a different direction and wrote to the CEO of the insurance company stating that I felt that this was an unfair practice and that denying an appeal without reading it was essentially denying the appeals process altogether. So they are now reviewing the appeal and I am hoping that they will process it due to the sleep apnea. I presented them with a lot of information since our insurance contract does cover surgical option for obstructive sleep apnea and although I use a bipap machine it is creating further problems by irritating my skin enough to create cyst (I have a history of having MRSA which is treated through hospitalization and very expensive iv antibiotics). Anyway my logic is that I am not always able to be compliant with the bipap treatment, which could lead to further complications. I also presented the statistical information on how poor the outcomes are (less than 60% on the high end) for other forms of surgery utilized to treat sleep apnea...etc, demonstrating that WLS is the only surgery that is a proven curative treatment to sleep apnea. The other interesting piece of data is that there is some research documenting that sleep apnea may actually exasperbate and contribute to obesity. Do your research and present it for your appeal. If they don't review your appeal keep fighting. I don't know if it will work, but keep trying. Kathie

Hi, I actually had to appeal a revision and used my obstructive sleep apnea as part of the reason for the revision. I have other problems too but it worked. I was denied as not medically necessary. The approved the original surgery with no problem. Because I was not 100 pounds over weight when I needed the revision they denied. I actually quoted websites on how the surgery helps sleep apnea. I have a copy of an appeal letter if you think it will help. Just email me and I'll send.