Medical Mutual

Well Medical Mutual denied my appeal due to 1. No true independent documentation of failures of non-surgical methods of weight reduction. 2. Also, no documentation that the I had received counseling regarding post-operative cosmetic difficulties. 3 No documented history of morbid obesity being present for five years, this one is insane. These were not the reasons listed on my denial letter dated 9/15/04. These are totally new ones and they were given on the last level of the appeal process so it now goes to an Independent Review Agency through the State Dept of Insurance. MMOH's actions were malicious to say the least. If these reasons were given on the denial notice of 9/15/04 I could have refuted or developed a response but as it stands I am not permitted to send in any further information. In the mean time, I went to my physician with the denial letters and a plan. I told her I would come in once a month for weight checks and with a food diary. I had started to cut back Monday 10/18/04. I had my appointment on 10/22/04 and to my surprise I had lost six pounds. All I did was eat when hungry and stopped when I was satisfied, no food was off limit but I was more conscious of the low fat ones. If this appeal is denied I cannot submit another claim for six months, so I decided to at least have six weigh-ins under my belt. I also plan to star****er aerobics. Even though it is only six pounds, I do feel better. I have also incorporated Whey Protein shakes mixed with slim fast in the morning, this does wonders I don't seem as hungry at lunch, so I make better choices and around 4 pm on that drive home I sometimes have one mixed with water so when I walk in the door I don't pick up the first thing that isn't nailed down. This allows me to think and prepare a meal. My physician also recommended a wonderful web site called www.AmIHungry.com it is the story of an MD who also has had struggles with weight. I have not have ruled surgery out but for now I feel the light at the other end of the tunnel is not an oncoming train with Medical Mutual Stamped on the front.

Martha, I understand where you are coming from with Medical Mutual. They gave me the run around also. I dont see how they can deny you. I was told because my BMI was under 40 (it is 39) I also suffer from high blood pressure, sleep apnea, heart condition. They are the worst insurance to deal with. I also sent a complaint to the Department of Insurance, but they could not help me. It seems like to me that Medical Mutual comes up with new excuses everytime they deny you. Good Luck!

DON"T GIVE UP!!! They denied me twice and I had to file with the Ohio Department of Insurance. I got my letter from that appeal friday and they state my denial from Medical Mutual should be overturned. I go monday to schedule my surgery! Please e-mail me at [email protected]. I have plenty of info for you! They denied me for the same info!!!!! I beg you to e-mail me! Jamie

Hi Martha, Glad to hear that you are taking measures into your own hands & have lost 6 pounds!!!! What I can say to you is that Med Mutual pulled the same crap on me it was absurd!!!! My situation was a little different than most because we are a self-funded group....but I can say, if I wasn't I would have had a real good case against Med Mutual for fraudulent reasons for denial (the whole scenerio is in my profile). So, with this said, if it's surgery that you seek, DO NOT GIVE UP!!!!