Question:
What is considered a life threatening condition?
My insurance states that it will not cover WLS unless there is a life threatening condition that will be improved by significant weight loss. I have high blood pressure and sleep apnea. My HR "Professional" said those would not qualify because they can be controlled. I just wondered if anyone else had experience with this. — Lynda D. (posted on November 28, 2002)
November 27, 2002
I would find another "professional". Both of those are
considered life-threatening co-morbidities....or they were by my insurance
company. Even reflux is extrememly serious because of the serious damage
it can do to your esophagus, the asthma it can aggravate, etc. You need a
PCP that is a bit more supportive, in my opinion. Do you have any joint
pain, back pain, breathing difficulties? Hang in there....e'mail me if you
need to chat!
— Scarlett A.
November 27, 2002
I read your profile, I thought a BMI over 40, was a comorbid in itself, and
yes high blood pressure, can be controlled, with drugs and so can apnea,
with a cpap machine. I have diabetes type 2 and it is somewhat controlled
with drugs and insulin, but the surgery, will hopefully in most cases,
stop, or prevent the long term effects and damage our comorbids, are doing
to our bodies. Maybe he is not WLS friendly. I would call the insurance
company directly and ask them.
— wizz46
November 27, 2002
When I went through the pre-approval process, I pointed out that both of my
parents are diabetics and I have high blood pressure in my family, though I
never had any of these things...yet. My point was that I could be avoiding
these diseases by having the surgery now when it was also less risky
without those problems. Just a suggestion. Good luck!
— Yolanda J.
November 28, 2002
A person in personnel has decided that a fatal breathing disorder is not
life threatening? See a pulmonologist and get copies of the pages from his
physiology book. Sleep apnea kills. Usually behind the wheel, but those
"heart attack in his sleep" are also sleep apnea. Oxygen
deprivation is deadly. All you need is some documentation to back you up.
A CPAP or BiPAP is not "cured", only treated. DON'T get me
started on this, and the high BP that goes with it. GRRRRRR.
— vitalady
November 28, 2002
This is the original poster and I want to thank you for your input. I have
all my information into the insurance company, I just called the HR person
to verify a contact person, and she kept asking me questions, and then
proceeded to tell me that I would probably not be approved. Fortunately,
it is not up to her to approve me. I only hope and pray that the doctor
that reviews my information is more informed than she. I was needing some
support, and you provided it for me. Now if I can only survive the next
couple of weeks of waiting.......and praying....
— Lynda D.
November 28, 2002
My PCP found 3 co-mords that were life threatening. I had a very
unsupportive PCP who actually withdrew from my case and now have a
wonderful, wonderful PCP who will not lie, but who will frame the issues in
lingo that insurance companies need for approval. Both sleep apnea and
high blood pressure can kill you so find a doctor who is willing to take
the time and outline the things the insurance co. needs. I don't know what
the HR person knows. My high cholesterol could be controlled with
medication but my dr believes there is a good chance it will come down with
weight loss and wants to wait until I lose weight to treat it. Something
that can be "controlled" is not key. I'm sure that most co-mords
can be "controlled" with medication but the goal is for them to
not exist.
— susanje
November 28, 2002
My insurance had similar wording. My two main co-morbs were also high
blood pressure and sleep apnea. I was afraid that the insurance company
would decide that surgery wasn't medically necessary to control those
factors, but they DID approve me.
— sandsonik
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