Hypothyroidism as a comorbidity? Anyone?

on 9/1/09 11:59 am
Hi everyone,

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!
on 9/2/09 5:04 pm - somewhere, MI
I dont think it counts as a co morbidity no. I was diagnosed as an 8 year old and my 7 year old has it too. I dont thikn it's considered life threatening as it's considered eaily controllable and not caused by weight.

good luck though... usually you can find comorbidities if you are in need of wls so definately talk to Dr...and get a sleep study.  The ankle thing really MIGHT help you get approved. I know someone who was approved because of her knees... not sure what it was called or anythng but she used to have to take injections t her knees and after wls no more... 
5'5" HW-344 (10/4/09) SW-295 (10/7/10) CW-161 GW-144
Never give up, Never surrender! ~Galaxy Quest

First person to tell me I took the "easy" way out is getting a black eye!
on 9/2/09 9:55 pm
You are right -- it doesn't count.  I found out yesterday the appeal was denied.  We are going to try another appeal with a medical necessity letter from the foot/ankle surgeon; my husband is also going to talk to the human resources person at his company, since they have all these riders added on to UHC's normal policy (it's his company that requires the comorbidity, apparently, not UHC), to see if an exception can be made in my case.  I can't imagine that's going to get us anywhere, and we will probably end up self paying.  Apparently, I can go ahead with the wls right now, and my claim can be resubmitted six months from now -- and I should be easily approved at that point, because my BMI will have been over 40 for two years, and I'll have the current comorbidity of high cholesterol.  My six month supervised diet and psych eval will still be good six months from now, too, which is good.

One way or another, I'm getting this surgery.  I pray we won't have to pay for it, but not getting the surgery is NOT an option.

Thanks for reading that huge, long email and responding!