[seashells]

Good morning everyone. As I slowly walk down this path to an amazing new life, I'm finding more questions than answers! Please help if you can:

1. I have BCBSNC. It lists that it will not cover gastric bypass if you have an endocrine disorder. So, I run to the internet, look up endocrine disorders and lo and behold, the very first disorder listed is diabetes!!!! I have hypothyroidism, which is well controlled by medicine. My doctor confirms that my disorder is not the reason why I am morbidly obese. So, my questions are:

a. Has anyone (that ya'll know of) been approved for surgery with hypothyroidism and the no endocrine disorder rule? Is this rule considered an "exclusion?" Are the insurance companies leaning toward the misconception that endocrine disorders=morbidly obese for life?

2. I have TRICARE standard/extra as well. Can anyone please tell me where I can find all of the current criteria for approval of gastric bypass surgery online. Also, if BCBS won't cover it, because of the endocrine disorder thing, would TRICARE?

3. Does TRICARE have a weight history qualification? If so, what is it. I know about BMI etc.


And finally, I completed a sleep study this week. OMG!!!!! I'm very concerned. I did not sleep at all (according to me) and I expected that they would ask me to come back. They did, but not for the reasons that I had!!! She asked me how I slept and I told her "terrible, I didn't." Then she said "Well, believe it or not, you slept alittle bit. We are very concerned about what the doctor saw while you slept. We need you to come back in, do another overnighter AND stay for a daytime study as well." Then she dropped the bomb, Your chances of having narcolepsy are very high and we need to rule it out." I'm still reeling from this, stayed up all night on the internet diagnosing myself. I thought that I had sleep apnea, but, certainly not narcolepsy!!! I do not suddenly fall asleep, but, I wake up very tired most of the time. I snore, I stop breathing etc. but, I wasn't, in my wildest dreams, expecting this possible dianosis. If there is a "silver lining" in my cloud, it may be that narcolepsy is a comorbidity. I have to keep my sense of humor. Has anyone hear been diagnosed with narcolepsy and had gastric bypass surgery?

Sorry that this is so long... thanks for all of your help. Everyone of you here help so many people.

[kbfrmaz]

I wish I could be of more help- but here is what I can offer! I DO have an endocrine disorder with my thyroid and as long as it was controlled and documented that it was controlled I was approved. (with BCBS). I had to show that I had seen an endocrinologist within the last 6 months to a year and that my blood results had to be stable. This disorder was discovered during my approval process so it took me a lot longer than others to get surgery since I had to have it stabilized. Since yours is already stable, that's a good thing.

Call your insurance and ask specific questions- I would be surprised if diabetes would count you out- since it is highly cured and reduced by bypass. They probably just want proof it is well controlled prior to surgery. (it seems to be one reason a lot of people are approved- as a comorbidity)

Anyway- wish I could be more help. Just ask a lot of questions from your surgeon and insurance and gather your medical records. Let us know how the sleep study goes!

[seashells]

Thanks so much for your quick response! I don't have diabetes but I was confused because of the "no endocrine disorder thing" when diabetes IS an "endocrine disorder thing." Thanks again, your thyroid info is encouraging.

[DocSanae]

The very basic criteria that the insurance cos go by is the NIH guideline.
http://www.renewedreflections.com/fo...s-surgery.html
Then the insurance cos add their own criteria on top of that.
You should call your insurance co and HR of your company to check the specifics of your policy, as the conditions differ with each policy. You need to find out what the exact policy is for your contract.

As for endocrine disorders, type 2 diabetes is specified as a comorbidity by the NIH criteria, and as kb posted, it is resolved at a very high ratio with gastric bypass so that is more a reason for approval rather than denial. At any rate, if you have any medical issues, whether physical or mental, they all need to be under good control before you can be approved for surgery, as uncontrolled medical issues are in themselves risk factors for surgery.

Narcolepsy is treatable, so getting a diagnosis is upsetting, but that doesn't mean it's the end of everything. It does improve with weight loss, so that shouldn't be cause for denial, either.

In any case, you need to confirm the exact conditions of the policy you have, even if other people have the same insurance co as yours, that doesn't mean everything is the same.

Good luck.

[ilovemykids]

You should check with Tricare. If I remember correctly...A BMI of over 40 or BMI over 37 with comorbidities. At least 100 lbs over your ideal body weight. I qualified because I had a BMI of 41 with no comorbidities that were diagnosed. (Pretty sure I had sleep apnea, just never did the sleep study. That was my next step if I had been denied.)
Hang in there and find out the particulars from all your insurance companies. Whatever doctor you choose should also be able to tell you. They are usually good with what insurance will and won't pay for.
Good luck!