I'm in the process of trying to get a lap band. My insurance company (UHC) requires a BMI over 40 for at least three years OR a BMI of 35-39 for at least two years with evidence of a comorbidity, and the completion of a six month supervised diet. I completed the diet last month, only to find out that UHC issued a denial because there was no evidence of a comorbidity submitted in my claim. I've always had high cholesterol and had it checked this year -- when my BMI is already over 40. Apparently I need to provide proof that my cholesterol was high when my BMI WASN'T over 40 -- i.e., the last two years. Unfortunately, I didn't have my cholesterol checked in 2007 or 2008 because I was either trying to get pregnant or pregnant (I had my baby in June of 2008).
The insurance specialist at my surgeon's office submitted an appeal, citing hypothyroidism as my comorbidity -- she said she's seen insurance companies accept this before, but I think it's a huge stretch, especially since this is not one of the comorbidites specified in the info. at uhc.com.
However, during my pregnancy, I had a heart condition that was likely caused by my thyroid - I had an irregular heartbeat and ended up in the ER with SVT (supraventricular tachycardia), with a heart rate over 170. I was put on beta blockers for the last trimester of my pregnancy. So to sum up, in 2008 my thyroid definitely was the cause of a potentially life threatening condition. I'm not sure whether my surgeon's office had access to this information, as I only found out about the appeal after it had already been submitted...
If anyone has had hypothyroidism, or a thyroid related condition accepted as a comorbidity by UHC, I would love to hear from you. I won't hold my breath on this one.
I also have PTTD (Posterior Tibialis Tendon Dysfunction) in both of my ankles; this condition is also caused by obesity. It's very debilitating and a foot/ankle surgeon has said my right ankle needs surgery to correct the condition. Is it worth including this in the next appeal???
Sorry this is so long -- thanks in advance to anyone *****ads and responds!