Question:
The cost of continuing to treat co-morbids vs. the cost of surgery

I want to know if anyone has info that compares the cost of treating obesity related co-morbidities to the cost of having the WLS. I am trying to draft an appeal and I want to include the average cost of say... prescriptions or knee surgery or whatever. If you have that type of info or know where I can get it please let me know. I have tried to look in the library but I can't find anything. (Bless the Library, it is a lifesaver sometimes:>) I would like as much information as you guys can provide. Thank you for the help in advance!!    — Brandyraj (posted on April 26, 2003)

April 26, 2003
Ok: Let's assume that a person is 100 or more lbs over weight, which as we all know can and will eventually cause a whole slew of problems. So let's list some of them and the cost of treatment. Also, let's note that a morbidly obease person's life time is generally not very long so for the sake of argument lets say a person was 20 when they started seeking medical help for their weight problem that this person avoided surgery for whatever reason and only lived to be 40. OK PEOPLE>>>>If you are currently being treated for ANY co-morbidity of obesity, please email me with a list of supplies you are perscribed to and the average cost of those supplies for one month and I'll complie the info together and post it on this site. IE...if you have type II diabeties, please tally up how much it costs YOUR INSURANCE company or just YOU for say 1 year. Then email it too me at [email protected]
   — Renee B.

April 26, 2003
This is exact;y what we did with my husband's appeal letter! His BMI was 38.5 and our insurance only covered surgery for those with a BMI of 40 or greater. I actually wrote his letter. When it went before the board (a panel of nine MDs), the administrative secretary said one of the docs asked if the letter was written by an attorney! (I work for the insurance company, but they didn't know it was my husband.) So, first of all, you don't have to be too specific on costs, because "possible" costs are impossible to pin down! You are dealing with people who are well aware of what a knee replacement and subsequent therapy costs (not to mention how much any conservative treatments such as arthroscopic procedures, Synvisc injections, therapy, and antiinflammatory medications would cost the plan before getting to the knee replacement.) My husband does not have heart disease or diabetes (but a strong family history) and he was diagnosed with insulin resistance (a strong indicator of developing diabetes down the road). I brought up the cost of treating diabetes and possibly heart disease. (This is where you just can't come up with any costs, but diabetes can be astronomically expensive - kidney damage requiring transplant, possible amputations, etc. $$$$. I'm not saying thoses things would happen, but are always a possiblity even if a diabetic takes really good care of themselves.) I included his insulin levels (and a copy of the lab reports as addendums) as well as his lipid levels (he is on Zocor to lower cholesterol). At any rate, no only did his surgery get approved, but the company changed the criteria to include those with BMI between 35 - 40 with co-morbids such as diabetes, sleep apnea "and so forth" , (I love thoses 3 little words - they left the door open to a lot of possibilities there!) You can e-mail me if you want help putting a "spin' on your letter. BTW, I also included language from the NIH statement as well as a copy of that statement with the appeal letter. Best of luck!
   — koogy