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Preexisting GERD as a comorbidity?

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Someone I know approached me on whether GERD is a comorbidity for insurance purposes. This person has a BMI of a bit over 35 and their primary medical health problem is a long-standing case of GERD (gastroesophageal reflux disease). Has anyone seen GERD accepted by a health insurer as a comorbidity to approve gastric bypass surgery?

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From what I've read, GERD is occasionally listed as a comorbidity but they seem few and far between:  https://www.obesitycoverage.com/insurance-and-costs/pre-approval-process/comorbidities

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)

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Of course our insurance systems are different, but I've only ever seen GERD accepted as a reason for revisional surgery to be approved. There are other less invasive surgeries that can be performed to resolve GERD. Let's be realistic, insurers are going to go with the least expensive solution to an issue.

Edited by Aussie Bear

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Hi folks,

A member asked me to comment on this even though it's an older thread so I'm happy to try helping out.

The RNY gastric bypass is considered the anti-reflux surgery of choice by surgeons in the field and I'm attaching a PDF with more information that might help.  The Recommendation is on page 8:  "Due to concerns for higher failure rates after fundoplication in the morbidly obese patient (BMI >35 kg/m2) and the inability of fundoplication to address the underlying problem (obesity) and its associated comorbidities, gastric bypass should be the procedure of choice when treating GERD in this patient group..."

GERD certainly is a central issue for band removal / conversion cases but also for sleeves which need revising due to new-onset GERD, which can be quite severe. Documenting the severity of the GERD will matter a great deal and it will be important to have a full reflux work-up establishing a failure of lifestyle modifications (e.g., eliminating acid reflux inducing foods like coffee, chocolate, red sauces, etc.), elevating head of bed, not eating after certain hours etc. with regard to reflux being improved. After lifestyle management "fails" it is important to demonstrate a failure of medical management with anti-reflux medicines will help establish medical necessity. It is really quite a misunderstood and under-appreciated comorbidity!  guidelines-for-surgical-treatment-of-gastroesophageal-reflux-disease-gerd.pdf

Hope this helps. Email or call us if there are questions or concerns I can help with.  The link is in my signature.

 

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