Denied and Devastated

After waiting patiently for over six weeks, I received my letter from Medical Mutual today, and I have been denied. I am sooo upset. My daughter is getting married in October and I wanted to look nice for her wedding instead of a big fat sausage stuffed into a dress waddling around on sore knees with no stamina. They said I failed to provide clinical documentation of weight loss attempts. Does that mean I have to spend more money on doctor's diets that don't work? How do I go about appealing? The financial counselor at the Cleveland Clinic has been MIA and not returning my calls. What can I say that will make them reconsider? Thanks!

This is not uncommon, you may need to go through a specific weight loss program supervised by a Dietician. I had to do this for 12 weeks. I had a dietician friend who met with me weekly. Ask your insurance specifically what they want, so you do not spend unnecessary time and money. OSU has programs that meet these criteria. I hated having to go through all the hoops but in the long run it was worth the extra knowledge as this is a huge lifestyle change don't look at it as a quick fix. mel

Hi Joy: Why don't you check out where I had my surgery done. I live in Parma and I had my surgery done at Northern Ohio Bariatrics. They are located at Parma Community Hospital. They have a great dietician there named Becky. It is not as large as ST. Vincents program, or probably not as large as Cleveland Clinics. You should give them a call and see if they accept your insurance. You won't have to prove dieting attempts but you will have to do the six months of dietician visits. You would not make it for your daughters wedding in Oct but you will have something to look forward to after the wedding. You will be happy at the wedding knowing that the surgery is just a few months away. I had my surgery in Jan. It is a WONDERFUL program the Drs. surgical assistant's name is Christina and she is the most loving person. We have support group meetings the first Monday in every month. If you are interested please call and I will give you info. EMail me if you want the number OK? Like I said the prgram is not as big as the other two but smaller does not mean less better it just means more personal and you don't feel as if you are on a conveyor belt. Good Luck to you. Denise in Parma

Medical Mutual - gee where to start!! I was denied, twice, by them. I filed my own appeals. For the 1st appeal, I had my PCP write a letter of appeal for me. In the meantime, I started seeing her every month. Then, the second time around, I wrote a letter asking for an independent 3rd party review and sent that in along with the notes from my monthly doctor visits and a letter from my psychologist. They always re-review the case before it's sent out, and low and behold, I was apporved. I think they knew they had no chance to win. Plus, they explicitly want to see 6 continuous months of dieting. Your doctor has to write it down, every month. Hope this helps Sharyn

Joy, I had the same insurance. They want you to do everything they ask. They will not back out of nothing. Just do as they say and they will approve you. You have to meet all the requirements. I had the 6th month supervised diet. I went to my pcp for 6 months for weigh ins and he put me on a diet and we talked about excercise. I did this the same day each month for 6 full months. Once you reach all their requirements. They cannot deny you. Also make sure you have a in the network surgeon. and 5 years proof of over a 100 pounds bmi of 40. Also I lost no weight I lost and gained the same 5 pounds. I would get in tomorrow to see your pcp and get this started. you cant argue with them. I tried that. They have all the control. If you meet all their criterias. there is no legal way they can denyyou Beat wishes barb

I'm sorry to hear about your insurance being denied. I hope that you can be successful with an appeal. Good luck. I'm hoping that I don't have the same problem with my insurance. It took me five years to finally, finally decide this is the route I want to go. I want insurance to approve me NOW....I'm not very patient. Haha.