Question:
how many co morbid

how many co morbids do you have to have to get approval for surgery. my bmi is 40    — julie B. (posted on February 24, 2003)

February 24, 2003
Hi Julie.. every insurance company is different, some get approved with no comorbities at all, others are 'required' to have a certain number.. it will be dictated by your policy. If you haven't already you might call your insurance company and ask them for the qualifying criteria for WLS. Best of luck to you, one Julie to another. ~Peace!
   — Joscelin

February 24, 2003
Just want to add that, no matter what they tell you on the phone, tell them you want it in writing. My insurance company told me over the phone they didn't cover the surgery, although I was reasonably sure they did. I asked for it in writing and, while they don't cover any treatment for 'obesity', since it's not a disease, they do cover surgery. If I had taken their word for it, I wouldn't have known any better.
   — garw

February 24, 2003
Like the others said, it varies drastically. If you have diabetes kind of bad or sleep apnea you are probably a shoo in, assuming your policy covers WLS. Those 2 co-morbs are considered very serious. Things like arthritis and GERD are also co-morbs but won't carry as much weight for a 40 BMI. This is assuming you don't have crippling arthritis. Like the other said, call and find out what they require and if they give you garbage about it isn't covered, then get it in writing. Look at your policy book and see what it says under the exclusions section. If it just refers to treatment of obesity not being covered then they are saying, by omission, that treatment of MO is covered if medically necessary.
   — zoedogcbr

February 24, 2003
I think it solely depends on what your insurance company requires or excludes. My insurance policy stated that it didn't cover charges for weight reduction programs or services and supplies for treatment of obesity. Then I read the fine print, which basically stated "except surgery for mobid obesity for a life threatening condition". I myself didn't have any very serious co-morbids. I had documentation from my PCP and from my chiropractor stating that I had degeneration of my joints along with pain. And that I had shortness of breath with even minor exertion and a history of diet failure. That was it. Once everything was submitted along with my psych evalutaion it was less than a week before I heard I was approved. Any documentation that you have, even if you think it's minor, will help your case. Good luck!
   — Laurel C.

February 25, 2003
Julie, It all depends on your insurance. I have a BMI of 40.5 with NO cormorbs and I was approved. Check with your insurance. You qualify under the NIH (National Institue of Health)guidelines because your BMI is 40. Good Luck.
   — Jan S.