Question:
Detailed List of co morbidities

I don't suffer from high blood pressure, diabetes, rashes, high cholesterol, arthritis, or any comorbidities that I frequently read about. My BMI is 44, but my physician says I will have a battle with ANY insurance company to pay for WLS. Does anyone have a detailed list of accepted comorbidities that I might refer to?? Thanks very much! I guess I should be grateful I don't have any of those illnesses, but it's a bit of a double edged sword too.    — NicoleG (posted on January 23, 2002)

January 23, 2002
I don't know where your doctor is getting his information, but he's wrong. Look at all the people on this site who have had this surgery. Insurance has paid for most of them. Also, for the most part, the surgery is recommended for anyone with a BMI over 40, or a BMI over 35 with co-morbidities. If your insurance pays for the surgery at all, I'm sure you'd qualify.
   — garw

January 23, 2002
Theoretically, if you have a BMI of 44 or higher you don't need any comorbidities. From my experience and other posters it seems that it is a lot tougher battle to get insurance approval. Do you have any back, hip, knee or foot pain? Are you limited in your activities at all by being morbidly obese. Those are actually considered as comorbidities, and I would be surprised if at 44 BMI you didn't have at least some problem like that.
   — Dell H.

January 23, 2002
Here's my list, but the main thing is that this is a preventive surgery to keep you from getting all this stuff in the future, as it may be lurking around the corner: Oops, the just went to get my journal off the kitchen table and realized it's in the car. I'll get back with you after work tonite. My family doctor highly encouraged the WLS because he said if I didn't do something, I would be a real health risk. I'll get back at ya tonite after work.
   — Annie H.

January 24, 2002
I don't have an answer. I just have the same problem. I am 25 YOA, my BMI is 47. I have no diabetes, or high blood pressure, or sleep apnea, etc. And your doctor is not wrong. It depends on your insurance policy, not your insurance company. There is a whole bunch of people who do not have an exclusion clause on their policy. So do not have a problem getting approved if they have no comorbidities. If your policy has an exclusion that says "must be medically necessary", than you DO have to prove that it is medically necessary. It doesn't matter if it is preventive for future health problems. It depends on your policy. Some policies have a solid exclusion where they don't cover it at all even if your dying. YOu have to look at the words that your policy states.
   — [Anonymous]

January 24, 2002
I had a BMI of 44. 5'4, 261 lbs. I didn't have any battle. In fact, I was approved within 48 hours. My co-morbities were small - acid reflux, high cholesterol, joint pain (knees). I asked about co-morbities a few months ago. Check the library. I got some great detailed lists.
   — Goldilauxx B.

January 27, 2002
Ok, after many hours in frint of the computer, I did stumble across a couple of things that may count as comobidities! Correct me if I'm strtching here. 1) Acanthosis Nigricans - per my mother, have had this skin discoloration on the back of my neck since early puberty, I started menses at age 8 2) Activity Intolerance secondary to obesity. In a nutshell, after I move aroud a bit, I become winded. 3)Depression related to morbid obesity. I have Tricare Prime and know they do pay for WLS. After corresponding with a long post op who had her wls paid for by Tricare, I'm feeling hopeful! According to her, no comorbidities are necessary if BMI is greater than 44. The only problem with that is this. Could you imagine someone with a BM! of 40 GAINING weight just to qualify for her insurace company to cover it?
   — NicoleG

July 3, 2002
well i myself have kaiser ins. they said i was coverd for either MGB - RNY - Lap - Open if i have a doctors ok. So well I'm seeing him on the 31st of july I'll keep you posted i only have a bmi of 38- 39 im 5.2 and weigh in at 213 with alot of co morbities still have to prove some others i dont have to prove its in my records but here anyway i'll list them. I have x) depression x) rashes x) arthritis x) Activity Intolerance secondary to obesity. In a nutshell, after I move aroud a bit, I become winded, or wounded. x) sleep apnea x) irregular periods x) swelling & stiffness in your ankles and legs, hands arms x) joint pain knees and back x) High blood pressure x) diabetes while i was pregnant x) and i dont know if this counts but it should uncontroled urinary movement with coughing i literaly have to wear think pads 7 days a week 31 days a month to protect my pants x) frequent reacurring brocitis and if you go to my page I wrote a letter to my doc and pasted it on my profile to share I'm taking it with me on the 31st any more help, or suggestions for me or ??'s email me at [email protected]
   — Tina R.