[seashells]

Hi everyone

I'm a newbie here and I am glad to have found ya'll. I have a question well actually several; I have bad heartburn and acid reflux which has gotten profoundly worse as I have gained weight. Is either considered a co-morbidity? I also snore pretty badly and wake up feeling like I did not go to sleep. Do ya'll think that I should have a sleep study done? Oh, btw, I want to have gastric bypass surgery but I don't think that I have been morbidly obese long enough. Something about that statement seems so wrong!!! Last, but not least, I have BCBSNC- how strict are they with the weight history, any advise there? Thanks alot, ya'll are so encouraging!!!

[qt82699]

welcome!! i am glad you found us here, this site is the greatest!! not sure about your insurance question..about the sleep study, your dr. will do this is they feel it is necessary, not sure if the reflux is a co morbitity or not, but this is something they will want to check out for sure b4 surgery, due to possible ulcers...anyhow good luck with your journey, i am looking forward to getting to know u thru ur posts!!

[DocSanae]

Welcome to the board, thank you for joining us.
No, acid reflux is not considered a co-morb by the NIH guideline.
However, sleep apnea is, so, you should have a sleep study done, it does sound like you have sleep apnea.

((((((HUGS))))) May your journey go well.

[kimtindall]

I would suggest that you contact your insurance company and ask them if it is covered under your policy and what the guidelines are. THEN, I would call back and ask another person. Make sure that you get their names and even a call ref # in case you get 2 different answers. Also, the insurance clerk at your surgeons office may know a little more about your specific plans requirements. Welcome and good luck to you.

[ragdolldude]

Co morbidity issues can include several problems. Joint swelling with medication, diabetes, high cholestorol under medication, sleep apnea, back issues due to weight, and others can be included. I'd ask your primary doctor for an evaluation for the surgery. I'm sure you can review your records and see if you qualify. DAVE

[DeMarie]

Hello and welcome!
Start the ball rolling - call your insurance company and just ask if they cover WLS and what are the guidelines (just like Kim said - and document everything!)
Call/see your primary and bring up the subject - also ask for a surgeons name and then go to that surgeons seminar.
Those 3 things should really let you know where you stand.
Good luck!

[not quite Barbie]

Hi and welcome. Each insurance company has slightly different rules so it's hard for us to answer you. Typically, sleep apnia is a co-morbidity and GERD (reflux) is not. I started my journey with a BMI of 39 and only GERD so I couldn't get the surgery. I eventually went up to a BMI of 40 and then my insurance company gave the OK. I have Fed. BC/BS in Virginia.

Some companies require a documented history of efforts to lose weight. Things like Weight Watchers count, as well as visits to your PCP to discuss weight loss strategies so if you've gone to your PCP to try diet pills or whatever that can count too.

Good luck and be patient!

[seashells]

Thank you so much for your quick responses!! It's so refreshing to have a place to come to.

I have an update: My doctor just called with my results of my upper GI and uttrasound tests. He said that ultrasound was fine. But, my upper GI shows some gastric reflux (I mentioned that to ya'll in my original post) and it showed that my stomach is very slow to empty its contents. So, I swallowed the barrium, grossy-wossy and waited and waited. My Radiologist was great and he showed me that my stomach would not let go of the contents. Imagine, I had to do a 360 roll over on the table-to get everything to move. Nothing moved and I sat down for 15 minutes, messaging my stomach!! Eventually the barrium moved into the small intestine- it was very cool to watch the whole process on the machine.

Anyway, my doctor mentioned that this may be a concern regarding surgery. He said that the surgeon will make the final call. Also, he asked me a series of questions about my sleep habits during the day; how quickly I fall asleep in the car, do I fall asleep/feel very sleepy at meetings etc. I scored enough to justify a sleep study, so he's going to set it up. He is also going to call in a script for Nexium.

Wow, lots of stuff, huh? But ya'll already know all of this and I'm so glad that you do. Any thoughts about my stomach not emptying its contents? Personally, it's all the more reason to have a smaller stomach but of course, I'm not a doctor. What do ya'll think?

[greensgirl19]

I'm not really sure why your stomach didn't empty. Did your doc have any ideas? Did he recommend a sleep study? Sleep apnea can be really bad. You should definitely contact your insurance company to find out their requirements and criteria that needs to be met to qualify for surgery.
Oh, and BTW... welcome!

[Hookemhigg]

Do you have a website for your insurance? If so the book should be there that should tell you if WLS surgery is possible or not. Remember it is not usually up to the insurance company to decide it is up to the employer or group getting the insurance what type of policy they elect to choose to have BCBS write. So BCBS does not covering it if that is what the insured group asking for the coverage wants. However in my case I work for the State of Texas and our ERS does not have it as a procedure that is covered and it is written in as an exclusion. Hopefully the legislature will change that soon so that others can have it done. The finally started talking about it last year.