Question:
Has anyone been denied/approved for WLS with only MILD sleep apnea?
I have been denied during an appeal because I only have mild sleep apnea, AHI of 8. My CPAP setting is 12. I have several other comorbidities. What did you do? Have another sleep study? — ERICK B. (posted on November 27, 2001)
November 27, 2001
Yes, indeed. I was covered by Harvard Pilgrim and while I had
a bmi of 58, I didn't have many physical problems. I slept with
three fat pillows under my head to keep me from waking up gagging
in the middle of the night; so, my surgeon played up the sleep apnea.
I probably had a very mild case of it. I had some knee pain. But
that was it and my insurer approved me in a week.
— [Anonymous]
November 27, 2001
My C-PAP setting was only 7 and I got approved! Just keep bugging them!
Good Luck!
— spatricknm
November 27, 2001
the mere fact that you need a CPAP machine for Sleep Apnea should be reason
enough. no matter what you are rated at it is still a Comorbidity.
— sbinkerd1
November 28, 2001
I was approved with the same diagnosis - "Mild Sleep Apnea". I
never even got a C-PAP. My other co-morbidities were heel spurs,
depression, rising blood pressure (not yet treated as hypertension, but
probably should have been), and severe mentstral bleeding. I think what
made the biggest difference for my insurer was the letter I wrote
documenting every diet I had tried over 30 years, including the weight lost
each time, and the time it took to gain it back. I was able to remember 70
(!) different diets - all taken quite seriously. I included scanned
pictures of every phase of my wight yo-yos and ended the letter with
"PLEASE HELP ME - I DON'T WANT TO LIVE LIKE THIS ANYMORE". I was
approved in one day. Blue Cross / Blue Shield PPO. Good luck. Let me
know if you'd like a copy of my letter.
— Elizabeth G.
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