Question:
Appealing to insurance company for coverage

I don't meet the co-morbidity or BMI qualifications --- almost but not quite --- I'm looking for successful arguments made to insurance companies to cover the surgery. Especially to Blue Cross Blue Shield. I'm in Michigan. thanks, d    — dullrich (posted on November 12, 2009)

November 12, 2009
Donna, Can you please tell us why you are considering the surgery if you don't have the issues you mentioned? Do you know all the co morbidities. Do you have sleep apnea, acid reflux, high cholesterol, pre diabetes, high blood pressure or not 100 lbs overweight? all of these are considered life threatening. I just wanted to run by the co-morbids because some people have different ideas of what they are. It has nothing to with arthritis, herniated disks, etc. So, we can help you more if you provide more information. Perhaps just a supervised diet; like Jenny Craig would be a good choice for you. Thanks for letting us know.
   — Kristy

November 12, 2009
Hi Kristy, I have a BMI of 38 and am 80 pounds overweight. My insurance company requires 40/100 to qualify or 35 and 2 comorbidities. I have one --- arthritis --- an have been tested for sleep apnea. Don't have it but the study says I am a candidate for it and that weight loss is recommended. I am also a cancer survivor and want to make the case that the risk of re-occurrence (50%) is as life threatening as is diabetes or heart disease. I'm just anticipating a denial because I don't meet the 40/100 requirement and want to be able to make a convincing case for coverage. Hope this helps. thanks, d
   — dullrich

November 12, 2009
Donna, My BMI was just under the requirement. I do have high blood pressure and acid reflux with an extensive family history of weight related health issues. When my case was submitted, I requested the opportunity to submit a letter detailing my significant weight loss attempts and how my visual impairment impacted my life. I am legally blind. I also asked my retinal specialist to submit a letter regarding my condition. My gynecologist submitted a letter detailing my weight gain over the years. And of course my PCP and surgeon. I would request a letter from every health care provider you know who will be supportive and willing. Get as much input from as many physicians as possible. Studies clearly show obese individuals have higher than normal chance for developing certain types of cancer. Good luck to you.
   — dasie