Question:
I have mild sleep apnea.. can I still qualify for the surgery with Cigna PPO?

I am trying to qualify for gastric bypass and my doctor says that with my BMI of 40, I need to have more comorbs in order to have insurance cover my surgery. My sleep apnea results came today showing mild sleep apnea. There were no recommendations, just the results. How would I know if I need the cpap machine, which I suppose, would help my case with my insurance company?    — Clare S. (posted on May 9, 2008)

May 9, 2008
I was sent to the sleep clinic by my pulmonologist and once the results came back they were sent to the pumonologist and then he gave me a script to bring to a CPAP vendor. Where I picked up my machine. I guess it can be done through different channels but contact the people that did the study or the doctor that referred you for the stud and see what they say. Someone has to go over the results and refer you for the machine if you need one. Good luck brandyII
   — brandyII

May 9, 2008
Nancy is right. I was diagnosed with mild sleep apnea and went to see the pulmonologist who wrote the Rx for the CPAP. I had the CPAP 2 days later and have been sleeping with it ever since. My mild sleep apnea meant that I quit breathing 12 times per hour. Kind of scary if you think about it. Definitely a comorbidity!
   — GlitterGal

May 9, 2008
Have you asked your insurance company what their requirements are? Some companies BMI of 40 is enough or 30 with contributng factors, I would ask them, before i applied for surger I called the insurance company before anything else and asked what exactly i needed to have the surgery.
   — dapoohster38

May 10, 2008
I have CIGNA PPO (if your BMI 40+) over 12 months should qualify you alone, but you need to call CIGNA and ask what is the criteria, because they want that 6 month physician documentation diet and exercise without gaps. That is a big one! I'm waiting to hear from CIGNA now. I had to do psyche evaluation, nutrition and cardiology clearance first and an EGD. So, it depends upon your surgeon, but you have to call CIGNA yourself and ask for the criteria. That's very, very important. Good luck!
   — notjus4fun

May 11, 2008
If the apnea is bad enough to require a machine, the sleep lab should contact you to set up a titration test to determine your machine settings. If they don't contact you in the next couple of days, call the sleep lab. As for your insurace requirements, call them and ask them for their requirements. Your doctor may be swaying his decisions with his own beliefs about the surgery.
   — gonnadoit