Question:
A couple of months ago someone had a list of qualifications to be considered medicall
necessary. If anyone knows what I am talking about could you please leave it here. I am on my final appeal with my insurance and I thought I might use the list. Thanks!!! — Faith B. (posted on November 23, 2003)
November 23, 2003
According to my surgeon, medical necessity means having co-morbs. A
co-morb is an illness that you can die from. High blood pressure,
diabetes, high cholesterol, sleep apnea. You can't use these in your
appeal unless you have been diagnosed with a severe illness and are being
treated for it by a medical professional. I think some people call joint
problems, back pain and etc co-morbs but they are really not. Some ins. do
take those in consideration.
— Delores S.
November 23, 2003
I'm finding out the hard way that some of these co-morbidities, such as
hypertension, also have to be uncontrolled even with appropriate medical
treatment and medication...it doesn't matter that the medication that is
controlling the condition makes you feel like crap and sick every day...
— Le P.
November 23, 2003
It really DOES depend on your insurer and your policy by that
insurer/employer. Mine considered back problems a co-morbid and controlled
high-blood pressure. I agree that the strict definition of a comorbid is
that it is life threatening, but many insurers are including in their
comorbid list things that decrease your life's livability. I would suggest
you call your insurer and ASK. They have to tell you.
— [Deactivated Member]
November 25, 2003
Sharon Brittain has a very long list of co-morbs on one of her sites, and I
am using a lot of them (over 50 for me) in my appeal. I figure the more
stuff you can send them, the better it looks in trying to get approved. You
didn't ask for this, but Rona Scott printed an article on one of the
questions here about "costs and complications and what obesity costs
the medical profession" that I retyped and sent in also. It turned out
to be over 5 pages and looked rreally god. I can't think of the exact name
of the article, but I bet if you e-mailed her, she'd be glad to tell you
about it, or send you the article (or tell you what ? it was asked on).
Hope I've been of some help to you. If I can remember, I'll get back on
here and put the address from the article so you can look it up.
— bufordslipstick
November 25, 2003
P.S. I just looked at your profile, and thought I'd tell you of a few
things I sent in also. Again Sharon Brittain shows on her site how too
write a family medical history, and I sent one of those too. And I also
made out a diet chart of diets I've been on since I was about 10 yrs old.
If you can show where you've been overweight for awhile, I think this will
help too, (even though you are way younger (25) than me (43). Also, if you
have any co-morbs like sleep apnea, send in all reports from the tests.
These will show that you need the surgery too. Good Luck in your appeal!!
— bufordslipstick
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