I need advice!!!

I have been denied surgery by Medical Mutual of Ohio insurance. My question is this, should I try to appeal it myself or just have that Walter Lidstrom take a crack at it? If I should appeal myself, what do I need to do? I don't know if I am suppose to write a letter or the surgeon, or my primary care doctor? They listed their reason as "not enough documentation of non-surgical weight loss attempts". I really have never gone to the doctor to be supervised on a diet, but I have tried them all. I did do Optifast, but the hospital it was based at was Riverside Hospital in Toledo, Ohio, and it is now closed. How can I get records from something that no longer exsists? I do have two old weigh****chers weigh in books, but I don't know if they would help. Any advice would be so appreciated!!! Jane

Jane, You need to know excatly what type of documention your insurance company is wanting ex: 6 months of supervised diets etc. Then if that is what they want....go to you PCP and tell them you want them to start documenting in your medical records that one you are obese and two tell them you want them to get you on a supervised diet. If you have every been to weigh****chers or any where you had to pay for diet assistance try to get copies of those records. So, much of this is just a paper trail with insurance. You should also sit down and chart all them attempts you have made over the years on diets. Give a copy of this to your PCP trust me th more info you have the better. I had to have 6 months of a supervised diet with Aetna and now I want a TT and they want 3 months worth of documentation....I am down -122 pounds...of course I have sagging skin but insurance wants a paper trail. Its a game that all of us have to do....if after you submitt the paper work to them and get denied then I would take futher action, Good luck and don't give up! Karie

karie, keep me informed on exactly what you had to do to get your tt approved. i to have aetna and i know what a pain they are to get wls and srrounding cir****tances approved. i am down about 150 but am only 6 mo's out. did they say you have to be a year out or any kind of time frame on when you could have the tt and excess skin removed. my e-mail is [email protected]. any inside scoop will be appreciated. rusty

Jane appeal first before you go fo an attorney. Have the surgeons office help you with an appeal packet. Make an appt with your pcp and immediately start a once a month weight management visit with them. Have them document at the pcp's your weight and diet and exercise regimen that they are prescribing for you. Do this every month while you are waiting for your appeal . When yor surgeon is ready to send the appeal to medical mutual, make sure that you have included a letter written from yourself documenting all your attempts and co-morbidities. Also get a letter of support from your pcp. Sounds like a alot, but it's worth it. I was denied by med. mutual for the same reason and my appeal went thru. i have surgery in Jan on the 5th. If your appeal is denied, then reappeal it again this time using all the monthly weigh ins from your pcp. It will work!! Medical mutual is primarily turning everyone down at least once. they are requiring one year of documented weight loss attempts, however with what you already have, it may just be enough.