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Comorbidities needed for Insurance Qualification

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What is a Comorbidity and Why do I need them to Qualify for Bariatric Surgery

A comorbidity is a disease that is the result of or strongly related to a primary disease. As it applies to weight loss surgery, the disease is morbid obesity and the comorbidities are many. Morbid Obesity is a condition when you are severely overweight. A BMI over 35 is considered morbidly obese. Many consider anyone who is 100 lbs over your ideal weight morbidly obese.

Insurance companies typically require at least 2 comorbidities and a BMI of 35 or greater in order to cover weight loss surgery. Some insurance companies require more than 2 comorbidities before approving surgery.
Below is a list of common comorbidities of morbid obesity that are accepted by most major insurance carriers.

  • Arthritis
  • Sleep Apnea
  • High Blood Pressure
  • High Cholesterol
  • Type 2 Diabetes
  • Venous Stasis Disease (Collection of Blood in the Lower Limbs)
  • Soft Tissue Infections

Type 2 Diabetes as a Comorbidity

Type 2 Diabetes is extremely common in morbidly obese patients. Data shows that laparoscopic gastric bypass, lap gastric banding and other obesity procedures can reduce your dependence on medication and often completely resolve the condition. Less frequent comorbidities that are occasionally accepted by insurance include:

  • Congestive Heart Failure
  • Fatty Liver Syndrome
  • Gall Bladder Disease
  • Depression
  • Stroke or Stroke Risk
  • Inability to Carry Out Daily Activities
  • Psychosocial Stress Resulting From Obesity
  • GERD (Acid Reflux Disease)

Discuss your possible comorbidities with your Primary Care Physician. This shows that you have previously discussed your obesity related diseases with your doctor and will provide documentation of your disease. Here is a list of comorbidities (additional conditions or diseases) related to obesity which MAY help you in qualifying for weight loss surgery.

  • Family history of heart disease
  • Family history of stroke
  • Family history of diabetes
  • Family history of heart attacks
  • Hyperinsulinemia
  • Diabetes
  • High blood pressure
  • Coronary-artery disease
  • Hypertension
  • Migraines or headaches directly related to obesity or cranial hypertension
  • Congestive heart failure
  • Neoplasia
  • Dyslipidemia
  • Anemia
  • Gallbladder disease
  • Osteoarthritis
  • Degenerative arthritis
  • Degenerative disc
  • Degenerative joint disease
  • Recommended joint replacement from specialist
  • Accelerated degenerative joint disease
  • Asthma
  • Repeated pneumonia
  • Repeated pleurisy
  • Repeated bronchitis
  • Lung restriction
  • Gastroesophageal reflex (GERD)
  • Excess facial & body Hair (Hirsutism)
  • Rashes
  • Chronic skin infections
  • Excess sweating
  • Frequent yeast infections
  • Urinary stress incontinence
  • Menstrual irregularity
  • Hormonal abnormalities
  • Polycystic ovaries
  • Infertility
  • Carcinoma (breast, colon, uterine cancer)
  • Sleep apnea
  • Pseudotumor cerebri