Denied by Medical Mutual!!!

I am so upset! I called Medical Mutual today to check the status of my approval, and they told me I was denied as of today. The reason was of course"not enough proof of non-surgical weight loss attempts". What in the world do they want of us? I have tried so many things to lose weight, now I don't know what to do? I have already had one back surgery because of my weight, and I am sure I will be heading for another soon. The pain I have in my back and down my leg keeps me from enjoying much of anything. I really thought RNY was the answer for me, but I guess insurance rules me being able to be healthy. Sorry this is so long, I am just so sad. Jane

Jane~~ I am in the same boat as you are, and just as P****D off!! I was denied by Aetna for the same reasons as you were denied by your company. the Insurance companies JUST DON"T GET IT!!! The WLS would make SOOOOO many people healthier!!!! Then we wouldn't COST them down the road a few years... heart disease, etc... I have had YEARS of attempts... Weigh****chers, Jenny Craig (twice!), Dr. Phil's diet, South Beach, Susanne Somers, Atkins.... And, just because it wasn't closely monitored and recorded by my PCP, I am denied!!! Sometimes I feel like screaming until I pass out!!!! I also, had back surgery 3 years ago, and knee surgery last year... I have high BP & cholesterol...and a BMI of 42... I guess that isn't enough.... darn, they want a 'paper trail'.... had I known this 30 years ago when I BEGAN dieting.... GRRRR!!! I am giving it one last shot... a little "package" for them... writing a letter detailing everything... having my PCP send a letter... a letter from my husband... anything else I can think of... ~Best of luck to you, and a BIG HUG!! ~~Deb H

this happened to me but here is how to get approved. File an appeal with medical mutual. Have your doctor write you a letter stating your medical conditions and that it is medically necessary for you to have the surgery. They will again deny you. After that denial, file a complaint with the Ohio Dept of Insurance. You can go to their website and either print it off or fill it out on-line. They will contact medical mutual for documentation and then send it out to an independent consultant. If you have a letter from doctor stating medically necessary, they will rule in favor of you. Of course the letter from medical mutual will state that they are not wrong in denying you but they have to uphold the decision from the independent consultant. I first filed with Medical mutual 5/7/04 it took 2 months for me to get my first denial. After my appeal, I was approved for surgery 10/04 and had my surgery 11/12/04!!! If there is anything I can do to help you let me know. DON"T GIVE UP THE FIGHT!!!!

Sweety don't give up so soon!! I was denied in june by medical mutual for the same reason. I immediately started monthly visits with my pcp, for weight management. I also had my pcp write me a letter of support. My surgeon then appealed it in nov. and my denial was reversed. I have surgery on January 5th. You can do it. Also Medical mutual told me that they are requiring one year of non surgical attempts. Maybe the monthly weight management, combined with what i had already sent them was enough. good luck! email me with any question.

I started with Barix and was denied by my insurance (Medical Mutual) so I decided to go about it a different way. I started by going to my pcp and he has sent me for a sleep study . So hopefully I can be able to go through with this. Keep up the good fight. Tami