Question:
I need the medical necessity for federal insurances - HELP!

I need the medical necessity on federal insurance plans. I am covered for this surgery under a federal insurance plan. I do not have two co-morbities (only one). My BMI is 47.1. Gall bladder already removed, severe back pain, knee pain, incontinence, abnormal periods, limited mobility, fatigue, etc... I am appealing to the OPM. I want to show that my insurance company is not comforming to the federal guidelines. Plus, I want to demonstrate that other federal insurance companies are following the federal guidelines on obesity surgery. I plan to use this information and my medical background for appealing to the OPM. Thank you, Maurine    — Maurine S. (posted on December 21, 2000)

December 21, 2000
Maurine, All the problems that you have described can be considered co-morbidities. You need to have your surgeon document them when he sends in for ins. approval. Also if you have any documented problems that you have seen a specialist for, it would probably help to have your records for that doctor included or a letter from him/her stating that your obesity has caused or made the problem worse. Good Luck...Hugs~
   — Marni

December 21, 2000
Marni is right....if you have fatugue you should get tested for sleep apnea. Abnormal periods could be caused by PCOS. PCOS has been known to disappear after weight loss. Incontinence is also a co-morbidity. Have your Dr. check you for high cholesterol - this is also considered a co-morbid condition. It looks to me, Maurine, like you should meet the requirements for WLS. Go back and talk to your doctor or get the Bariatric Surgery policy IN WRITING from your insurance carrier.
   — careywatkins