Denial - But Why?

I called Care Allies, Medical Mutual's medical management, this morning and was on hold for 20 minutes only to find out that I have been denied. However, after talking with two people, including a nurse, neither of them can tell me why I was denied. At first they started telling me that my BMI had to be 35 with co-morbidity -- I told them it was over 50. They looked through the paperwork and found that. Then they said about diabetes, hypertension -- have that I told them. Then they asked if I was on dr supervised diet -- did that. How about prior weight loss attempts -- yes. Both of them then said to contact my doctor to find out why I was denied. I have an email and a message waiting for Latonya at St. Vincents. I am so upset. Last week I find out that the paperwork was never sent to the correct place and now that it is -- I'm denied.

Oh I'm so sorry that this has happened. After all this work you have gone through it just doesn't seem fair. I too have MM and most of the things I have heard have been ok about them approving. I hope and pray things get worked out for you soon. Tina

I am so sorry about your denial... it seems as though the medical people are so busy that they think they send it to the right people when in reality they don't . I hope this gets worked out soon and you can be on your way. I will be thinking of you hugs Jeannie

How about a pscychological evaluation completed by a LICENCED PSYCHOLOGIST or PSYCHIATRIST? Medical Mutual requires that as well. In my experience, even when we send everything, Medical Mutual has been known to deny. The good news is, I fax all info. along with a letter of appeal and the denial usually gets overturned in a week or two. Hang in there! Tracy Burch Office Manager/Insurance Specialist Dr. Trace Curry 513-559-1222 [email protected]

Winner Girl, I am so sadden to hear you are having such trouble. Its just aweful that the insurance company seems to have all the necessary documentation and yet a denial is their decision. Unbelievable. You know sometimes I feel that insurance is nothing short of LEGAL organized crime. They take your money and charge you so much and give you so little in return and then when you really need it.....FOR-GIT-ABOUT-IT!!! The only advise that I can offer you is to appeal, appeal, appeal!!!. Some times the squeeky wheel gets the grease. Just be passive aggressive about it. I know when people call me b/c they have been denied, the ones that are assertive yet kind and respectful tend to be the ones that you really want to work the hardest for. Its not favortism, just human nature. All in all it could be something as simple as the insurance company has a time limit for turning around requests and yours didn't get the time it deserved b/c of the previous issues. Im not sure about MM. Hopefully it is just a misunderstanding and you will be getting your date soon. I'll keep you in my thoughts and look forward to your title: I got my date!!! Kym

Winner Girl, I am so sorry to hear of the denial. Hang in there, you are a "winner" and you will get this denial turned around. Debbie

Be sure to appeal Med Mutual's decision. I was first denied because they needed the actual notes from my PCP of my 6 month supervised diet. Once they received that I was approved within days. I know how you feel, my stomach sunk when I first received my denial, thinking I've done all of this and now I've been denied. But stick with it and be persistant. Good Luck to you. Annetta