medical mutual

HI, i'm angela i'm pretty new to this site but i can't begin to tell you guys how much reading all of your posts has helped me with my research. I'm looking into doing the lap band surgery, but it will be in the fall at the earliest due to insurance issues. In the meantime, I want to learn as much as I can about how to make insurance approval quick and painless. When my husband is eligable for insurance he will be under medical mutual and I wanted to know if any of you has them as your insurance provider and if you could give me any hints or tips on how to get approved? In other words...what do i need for them? I would love your input and advice. Also, on another subject, i would love to put a picture on my profile and i can't figure out how. Thanks!! Angela

Angela, I think it depends on the plan that the company has that your husband works for. I have medical mutual, and for me on my policy, it is considered an exclusion. What I don't understand though is that it lists a lifetime benefit of $10,000. for weightloss surgery. I also just received an update of my policy that now includes prescription weightloss drugs as exclusions. This is what i don't understand, insurance companies do not want to pay for anything that can be preventative. They will wait until obesity has caused other "more serious" conditions that they will then pay for. I had RNY almost 6 years ago. The company I worked for then had Aetna as the provider. They paid everything but about $2,500. which was awesome. I wish you luck, hopefully his plan is different than the one my employer carries.

Hi Angela Thanks for the reply to my post below. I have Medical Mutual and they will pay at 90% with an out of pocket of about $1000. But I think all the MM plans have the 3 to 6 month supervised program. Best of luck Blessings Tina

Hi Angela, When you get your Medical Mutual card call them and have them fax or mail you a copy of what they require. I have medical Mutual and they do require a 6 month supervised diet and they are very particular how it is documented, I was denied the first time because my PCP did not have it documented how they wanted it so now I am repeating the 6 month supervised diet and hopefully reapplying in May. Good Luck on your journey. cheryl

Every MM poilcy is DIFFERENT. I had MM in 2003 when I had my open RNY. At that time and with my policy they DID NOT PAY FOR LAB BAND. They paid for either RNY or BP-DB. With my policy and at that time I needed a 5 year weight loss history, and letters from my PCP and surgeron. They paid 90% of everything at that time. Shortly after MY POLICY put a CAP of $10,000 for WLS. My paper work was sent in on 9-22-03 and was approved on 10-10-03. Just remember each policy is different, so like someone else said as soon as you get your card CALL them and find out EXACTLY what YOUR POILCY states. Good Luck, Robin

i just wanted to say thanks to all of you who posted replies to my questions about insurance. It really helps to know all of this stuff before i am eligable for my husband's insurance so that i can get started on the 6 month diet. I am so excited about getting the band so that we can start thinking about having kids in the medium-near future. I'm really glad i'm in nursing school right now because it keeps me from obsessing over the 6 months that I have to diet before I can have this done and then all of the stuff with getting approved and stuff. I'll be on here a lot to get help from those of you that have gone through it, so thanks in advance! Angela