Got Med Mutual's Letter & it is a Crock!!!!!!!!!!!!!!!!

Yes they pulled the "we didn't get all of the docments" with me too, mine just happened to be that they didn't get all of my weights...yeah right! Get your appeal together to, don't give up! I am hoping that all of us who are having trouble find a happy ending! Jen P.S. Why was your friend originally denied? What did she supply that changed their minds?

not sure, I will call her and find out. Medical Mutual requested photos of her for the last 5 years!!! She was a size 28 and is now a 12!!

jen-ranting is fine- but promise me that tomorrow you will write them the letter requesting copies of everything they used to review your case--it can be interesting reading--you will see how weak some dr's letters are! i used my second appeal time to build a case and submitted a whole notebook basically of stuff- and ended up they were ignoring my sleep apnea--so then that is why they overturned denial--i know- i am repeating myself-i also sent a copy to the insurance commish and to the pres of med mutual--so i really don't know who exactly out the bee in the bonnet to get it overturned- but i know that i created a paper trail and they had to answer to it! you MUST use your 60 days wisely! i am sorry that i cannot help you with docs --what about in wierton-across the bridge?my 1st hubby's got family there- sorry- got off track!

Hi There again, I faxed them a letter a little bit ago: TO: Medical Mutual of Ohio FROM: Certificate # DATE: June 29, 2004 RE: Request for Surgery Approval According to the letter sent by the Member Appeals Unit, the denial of my original request was upheld. I find that denial of this procedure is not justified and I will again appeal the denial. In the meantime, I would like all the scientific documents that were used in validating the denial. According to the National Institute of Health, dietary regimens fail to provide long-term weight control in severely obese patients. The failure rate for traditional diet and exercise programs is 90% two years after weight loss and this failure rate increases as time goes on. In addition, the letter stated that my request was reviewed by a licensed health care provider in the same or similar specialty as my request. It also stated that the reviewer was a Medical doctor board certified in Surgery. I would like more information on his/her qualifications such as what type of surgery he/she performs, what experience does he/she have with bariatric surgery and how many years of experience this person has in this field. Sincerely, Jennifer B In addition I emailed Walter Lindstrom & I asked my mom to talk to my dad (he is against me having this surgery) about what Med Mutual is doing to me. He told her that they are not to be using their criteria, they are to be using the ones that the union set forth. If they aren't, I should appeal my case to the board.... I haven't called anyone in Weirton. Someone did mention Dr. Reddy & he performed a colonosicapy (I know that I just butchered that spelling LOL). I don't believe he is a PCP because I know that he is now doing bariatric surgery.... Jen

OMG!! I am going through the same crap with MMOH!!! I have found your post and the replies very interesting because I have no clue how to appeal. I see my PCP on Thurs to see if he can write a better letter, and I am going to take a copy of these posts with me! See my profile...too much to type out again! http://www.obesityhelp.com/morbidobesity/profile.phtml?N=B1079122457 I have severe sleep apnea which my PCP said was enough on it's own to get me the surgery, but somebody didn't tell that to the idiots at MMOH! Wishing you the best of luck, we all deserve it! Keep me posted!! Pamela B.