MMOH Ins

Has anyone else heard about the most recent change in policy? I have MMOH SuperMed Plus. Applied for on 3/9 through CCBS. Had all the info that was required - I even checked with the ins my self - 5 yr weight history, medical need - type 2 Diabetes and the physch eval. When I called yesterday I was told that it was denied on Friday and I should recieve the letter in the mail in a few days. I asked why and was told they now require 3- to six month physcian supervised diet. So like being a diabetic for 20 years and seeing my endo every 3 months isn't a diet! From what I understand this is the 2nd magor change in this policy in the last 9 months. I am now considering selfpay - who is to assure me they won't change it again before the end of the 3 months?! If you have this type of insurance PLEASE call and verify that you have a diet noted in your Doc records and save yourself the dissapointment of being denied. GOOD LUCK to all with their journey.

Debby, I also have MMOH (Super Med). I found out on friday that I was also denied. They said that I was denied because I did not have a BMI of 40 over the last 5 years and they did not receive any documentation of me being on any diets from the doctor. My BMI has never been 40. My BMI is 38.3 right now, and I do have co-morb. I already sent an appeal letter along with all of my information again.

I hate to say this but if you want the surgery and your insurance to pay, you almost have to play their games. Mine requires 2, 6 month PCP supervised weight-loss/exercise plans with one being within the past 6 months. So I will start the one that I need now and hopefully by the time I am done and have had all of my testing, I will be ready to submit to my insurance company. Another thing you might want to check on is to see how many approval letters you need. I have to have 3 different ones (types). You'd think they would have enough paperwork to do!.... I wish you both the best of luck in your journey. Don't give up. You've come this far! Hugs to you both Lori

You need to find out when that policy change went into effect. If it was after you submitted your request, you can appeal on those grounds. Otherwise, I'd do the diet and re-submit. It beats the heck out of spending $20,000. out of pocket (or more) as a self-pay. We all had to jump through the insurance hoops - be gratefull that your required diet is a short period of time. Have you done Weigh****chers, Jenny Craig or any other organized weight loss plan? If so, they might accept it (Aetna accepted my WW) as long as you can get your PCP to put it in your file that you were going. Good Luck

I feel like a circus dog who was taught to jump through hoops...lol I actually knew about the supervised weight loss and had to within the last year. I started going to a dietician 2 weeks ago to make sure. I also went to a weight specialsit last year in July for a month but the pills he gave me made me sick. I also found out they will not pay for a lot of the pre-examines you need. For example they do not pay for my dietician visits. They do not pay for lab work. They do not pay for immunization. And they do not pay for ECG and EKG's. I was originally going through Cleveland Clinic who is resubmitting the forms under different numbers to get payment. Accordia is the Administrator on my plan and they SUCK!!!!!!!!!!!!!!!! Another thing you might want to check is that the hospital you useis in network and even if it is you will be out 1500 which is the max out of pocket per year for in network doctors. I was told BTC doctors are not in network but the hosptal is......Still researching the truth on that one.. Well good luck. BTC just sent my paperwork in yesterday. But I did have WW, Jenny Craig, L A Weigh****chers, Slim Fast, and all kinds of diest on there.

I wish you the best of luck, but I'm not sure that even the hospital is in-network anymore. They were in-network the early part of last year, but I had heard that they no longer were. The surgeons were not in-network when I had my surgery there last June. I hope your approval comes through o.k. Just be sure to read it carefully though. They approved my surgery but in the "fine print" it said that while the surgery is covered, the surgeon isn't. They just want you to be aware of that so you aren't surprised if you end up with a bill. They will pay it at the out-of-network rates which could leave you with a sizeable bill. Remember, out of network doesn't really have a true limit because (at least on my plan), you are responsible for your out of network %% (normally 30% of Reasonable and Customary), however, you are responsible for the difference between R&C and what was billed. I was lucky. Between my primary (Aetna) and my secondary (MMOH), I only paid about $1,500 out of pocket to go to BTC. They were worth every penny. Good Luck

Well.... CRAP! I've been sitting here waiting for my approval since I went to BTC on MLK day. They've hemmed and hawed (both BTC and MMOH), throwing up roadblocks to my approval left and right! When I called initially to ask about approving, the only thing they said was that the surgery needed to be deemed medically necessary. I'm sure most doctors would agree that, for me, this surgery IS medically necessary. I'm NOT wanting to go on a medically supervised diet prior to surgery. I'm ready for surgery NOW. Well, glad I checked in here! Thanks, Sarah

Here's the latest on MY craziness... The documentation of non-surgical weight loss attempts that MMOH requires is NOT the form you submit to BTC with all of you attempts listed. MMOH needs DOCUMENTATION from an MD! I just moved to Ohio in November. I've been to my PCP once. Prior to that, I saw my OB exclusively for about two years as my daughter is less than a year old, and I miscarried once before she was born. So... They want me to go to my PCP from 3 years ago -- whom I haven't seen since 2001 -- and have him document my weight loss attempts? What if I wasn't going to a doctor during those attempts? I've tried Jenny Craig (2x), Metabolife, Weigh****chers, TOPS, Adkins and a couple others as well as regular diet and exercise over the past 20 years. I've never really had one doctor that I've gone to exclusively. When I was in high school (12 years ago) I went to a doctor who prescribed medication for me -- that was medically supervised, but the man is dead! I asked BTC how I'm supposed to get those records. The woman at BTC said that the charts should still be available, but wouldn't offer me any further assistance. And here I thought BTC was supposed to be super-helpful for these things. I'm just getting so discouraged and thinking that I should give up... Sarah

MORE NEWS>>>> BTC Hospital is in Network The doctors are not in Netork. The doctor I have is Michael Adolf. And form his referals he is really good but he is not in Netowrk.

I have MMoh super-med plus and had my surgery at BTC on 1/21/04..BOTH the Hospital and doc...were out of network according to my insurance when I called... PLEASE check and be sure!!! it could be a hefty bill otherwise!