Heads Up for Medical Mutual

A number of you might have read my post about being denied. Latonya called and found out why. You will never believe this...............nutritional assessment. Now, a nutritional assessment was never on the list of need to do for Medical Mutual. A psych evaluation, five years of weight history, and a six month dr supervised diet -- those were the things on the must have list. Well, it is time to get a nutritional assessment done and hopefully get a little further down the road this time. I thought I would let others out there know that you never know what else Medical Mutual might throw in at the last minute!

I have Med Mutual and I did not have to have a Nutritional assessment. I did have to have a Physc. Eval., 5 yr. weight history and the 6 mths. supervisied diet. But understand even though we both have Med. Mutual, there are many different policies. Your's must dictate the nut. eval. Good luck in your journey, keep with it and you will get your approval. Just have patience and pray. I will be praying for you. Annetta

Well at least you have an answer and it wasn't anything that you did or didn't do. Im so sorry you are having all this trouble. I've been thinking about you and I hope that this will bring you one step closer to getting your approval. I'll keep you in my thoughts and prayers! Kym

I'm glad you are able to figure out what they need!

I too have Medical Mutual......and as stated every policy is different! That really is up to the employer as to what is covered. I had the psych eval.....6 month supervised diet...which by the way I had to do 2 times because my doctor didn't document precisely the first time....and I did not have a 5 year history to present to them. I had 10 years of weights but they were not consecutive as they wanted. I sent in pictures of me with one of my granddaughters from birth to 5 years.....can you believe that the accepted that?! I think if you are willing to work with them....they will work with you. It does seem like an incredibley long journey to have insurance approve you, but in hind site it really goes very quickly! If I had one word to pass on it is to document, document, document.....call them every day and write down who you talked to, what time of day, and what they said. Ask them to tell you the statis of the pre-detemination of case claim (give them the number assigned to you)......it does go to a different department that a regular claim.....I found out different things needed before my surgeon's office and could get it to MM asap.......called the surgeon's office...told them and that I was sending it to MM. They were fine with it! I would call MM back and find out specifically what they want to be approved! Good luck! Sue 325/goal 130/ current 122

Man, I sure hope that my policy doesn't need that......my file was sent to them last week and I didn't have that. I had everything else though....I'm keeping my fingers crossed. For those of you that say call them should I call them after just a week? I've been holding out but I was thinking about calling them tomorrow - is that too soon?

Hi, I am Tammy. I have Medical Mutual also. At the prescreenig they told Stacy all I needed was a letter of recomadation for the lapband being medically necesary.No diets or weight historys none of that. I had my physc eval, copy of my sleep study and DR. Ben-Meir gave them the letter. It took 3 weeks for a denial with me calling everday,so I missed March. Come to find out on the day they told me I was denied I got a letter of benfits from them stating they cut a check to the surgeon for my consoltation. So you pay the surgeon but you deny the procedure. Doesn't make sense to me. So I call And ask why the denial? Their response was no supervised diet for 6 months. I said according to prescreening back in January this wasn't required ,but now it is. Sounds like misrepresentation of benefits to me.I also question the fact that they paid the surgeon already. They really didn't have a comment about that. The next day calling them again asking what it is they actually want, they inform me that my case has been submitted for re-review and I would know on Friday. Well it's Sunday no word yet. They still haven't decided. I am calling them again tommorrow to see what the problem is. I have the documentation of a 6 month physician monitored diet, but right now they don't want it. Go figure.So theres Medical Mutual for ya. I hope to have my surgery in April if the insurance company gets it together.