Priority Health HMO and Lightweights
Hi Laura,
I also have PH. My BMI is 40.5 also. I went through the medical weight loss program at MMPC and was successful short term and gained it back IMMEDIATELY. My PCP also sent me for a sleep study and the headaches etc were related to the apnea. I love my CPAP.
Not a headache since!! Anyway, my PCP printed off the requirements from the website for PH and went over the criteria with me. If you go to your member page online it will tell you very specifically the criteria. I was approved for surgical eval immediately after I attended the seminar and have had all my appointments and am waiting insurance approval for actual surgery. (It has been over two weeks and I am getting nervous
to hear what they say) I chose Dr Foote. He is so very sweet and soft spoken. Your PCP is trying to give you an valid comorbid by sending you for a sleep study it sounds like. Here is the criteria for my plan: I have PH through Holland Hospital.
BMI > 40 and one comorb such as symptomatic sleep apnea,significant cardiac disease,hypertension on one or more medications,hyperlipidemia (high cholesterol etc) on max doses of one medication at least, or diabetes with hemoglobin A1c >7.0 (uncontrolled blood sugars). I think they also consider things like gastric reflux disease or arthritis as well. Hope this helps :) Any questions just ask. I am fighting the PH monster as well :)
Cathi
Not a headache since!! Anyway, my PCP printed off the requirements from the website for PH and went over the criteria with me. If you go to your member page online it will tell you very specifically the criteria. I was approved for surgical eval immediately after I attended the seminar and have had all my appointments and am waiting insurance approval for actual surgery. (It has been over two weeks and I am getting nervous to hear what they say) I chose Dr Foote. He is so very sweet and soft spoken. Your PCP is trying to give you an valid comorbid by sending you for a sleep study it sounds like. Here is the criteria for my plan: I have PH through Holland Hospital.
BMI > 40 and one comorb such as symptomatic sleep apnea,significant cardiac disease,hypertension on one or more medications,hyperlipidemia (high cholesterol etc) on max doses of one medication at least, or diabetes with hemoglobin A1c >7.0 (uncontrolled blood sugars). I think they also consider things like gastric reflux disease or arthritis as well. Hope this helps :) Any questions just ask. I am fighting the PH monster as well :)
Cathi 
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