Question:
They are telling me that my obstructive sleep apnea syndrome does not meet

there medical necessity syndrone even after 2 doctors recommendations have been submitted. My ENT says my obstruction in in my throat and that I would have to have 2 or more surgeries in my throat to fix the obstruction or I could have gastric bypass to loss weight which should benefit me there. What should I do next?    — CINDY D. (posted on July 11, 2003)

July 11, 2003
Are they denying you wls because of this? If not, go for the wls first!! you won't be disappointed. If you need a good letter, look at my first profile sharon brittain it has some good stuff there you are more than welcome to use!:~)
   — Sharon M. B.

July 11, 2003
I had my sleep apnea and was referred to a specialist. Needs surgery in muscle(pallette). Gave this to bcbs/nc still don't know if they will pass/still other comorbidities.
   — betty B.

July 11, 2003
Cindy, It may be in part too because of your BMI being 37.5 (according to your profile). Our medical insurance requires 2 or more co-morbidites with a BMI of 40 to 49 and none if the BMI is 50 or above. Anyone under 40 needs special circumstances to be approved. If you have any other co-morbidities, you may be able to appeal the decision but no guarantees.
   — [Deactivated Member]

July 11, 2003
Consider checking out the generic "Letter of Medical Necessity" on this site. First click on "Your Journey," then "Insurance Troubles," and then "Getting Authorization." You may have some of the comorbids that are listed here that you haven't thought of, and this should help with you insurance approval. It's a good letter with statistics and other information that you can personalize to meet your own situation. I had not realized that I had so many co-morbids until I read the letter. Also take into consideration any co-morbids that you are susceptible to due to family history. Good luck in your pursuit of WLS.
   — Beth B.