I have a question

Hi everybody!! I was denied surgery by Medical Mutual HMO Health Ohio due to "not enough documentation of non-surgical weight loss attempts." I then called my surgeon's office and was told not to bother appealing until I did a 6 month diet with my pcp. I started this right after Christmas and will weigh in every month. I am doing the Atkins diet which was my doctor's idea. My question is this...what is the insurance company looking for? Do they want to see me lose weight or fail? I don't understand, if I could do this on my own, don't they think I would have by now? That is why I want the RNY, to help me lose weight that I have never been able to do on my own. Well, I really don't want to screw this up so I can appeal in 6 months, so if you know, can you let me know do they want me to lose weight or fail? Thanks, Jane

Jane, It's a good question--I like to see patients lose, not gain, on supervised diets. Even if it's only 10 or 20 lbs over 6 months, it shows you are dedicated and can stick with a program. Plus it'll make your surgery lower risk as well. I believe the insurance companies follow this thinking as well. Good luck, Dr. C The Deaconess Surgical Weight Loss Center Cincinnati, Ohio (513) 559-2545

Jane, I too, have the same insurance. They just submitted mine today. I did do the 6 month supervised weight loss with my PCP.....thanking God that he documented everything. We started this because of arthritis in my knees not so much because of WLS. But along the way my orthopedic doctor and I had the discussion about RNY surgery and he is 2000% for it and wrote the most compelling letter on my behalf. I do have the 6 month supervised diet and lost 50 lbs. so far. I still have a long way to go but feel that what I take off before I won't have to take off after. All I did was cut back on fat and eliminated sugar. I know that I will have to do the same post op so thought it would help me test the waters pre-op. My surgeon was very impressed that I was taking it seriously pre-op. I will pray for you and hope that we both are approved! Sue

Hi Jane... I have a question for you... what, if any, kind of documentation did you supply the insurance company with that showed that you've tried non-surgical weight loss attempts in the past? The reason I am asking is that I got a letter from my insurance company a couple weeks ago (Medical Mutual of Ohio Super Med Plus) stating that they were requesting proof of non-surgical weight loss attempts from me before they would make their determination. So, I scrambled to assemble any and every shred of paperwork that I could come up with to send them. I am now awaiting their decision, which can take up to 30 days, from what they told me. I am quite anxious over whether they will accept what I sent to them as enough "proof", or not!!! I am going nuts not knowing what they really expect from us!!! Thanks and hang in there, Karen

Hi Karen, I hope you get approved, I will do the biggest happiest dance ever. My family Dr sent all my information to Med Mutual, he also sent a letter of recommendation. I had no problems getting approved. I have had my family Dr for over 17 years, I believe this makes a difference, (my opinion) I wish you all the luck. Jackie Cannon

Thanks, Jackie!!! Good seeing your post & thanks for the support... how's your post-op going??? Hubby having any luck with his job hunting??? If not, have him call me! How long did it take for you to hear that you were approved once you submitted all of your paperwork to Medical Mutual??? The waiting is pure agony... Thanks again, Karen

Hi Karen, sorry it took me so long to reply, as usual the kids were on the computer!! Anyway, my pcp wrote a letter detailing every diet I have been on, from Weigh****chers to Optifast and on and on and on. I couldn't provide proof for the Optifast because the hospital in Toledo where I went has since closed. I also did Physicians Weight Loss, but they did away with my records. I did find two old Weigh****cher books, but my surgeon's office says instead of trying to appeal now, to do the 6 month supervised diet first. I was told Medical Mutual is no longer approving anyone without the 6 month diet with your pcp. I have been at this since last summer, but I am not giving up. I am only 41 years old, and I am tired of living in pain.(back and knees) Good Luck to you, I sure hope you have better luck than I did, and get approved without having to appeal. Hugs, Jane

do you maybe have cancelled checks from the physicians weight loss etc??? if med mutual is saying 6 mos supervised it is one more hoop but will be worth it- it is all a game- to make sure that you truly are in need of this surgery and that you are able to work at something- as dr c said--the ability to follow thru is important- the weight lost is a plus for your surgical health.... better that they have added another hoop to jump rather than totally excluding! the ins part was the worst part of my whole surgery- and i have med mutual! jane- have you seen any postings about Baribuds mtgs in Orgeon? we meet on the 17th again and would love to get to know you- i am in lindsey---our mtgs are for anyone pre or post op and we welcome spouses, etc...we are NOT doctor affiliated as some groups are- give us a shot! email me for more info if you'd like- or my phone number

*sigh* I called my insurance just yesterday, Medical Mutual Super Med Plus PPO (self funded through Ohio University) and they did NOT mention a 6 month supervised diet. I was told: Letter of med ned from PCP, Diet/Obesity History for last 5 years, 5 years of medical records, and Psych eval. Their website, shows the same requirements. I'm aware there are diff plans though and self funded is different from regular, but they better not try to change what they've told me and shown me mid stream LOL...guess I wouldn't be suprised if they did though. It's my rotten luck! We can't give up that is for sure. Keep pluggin on!!! I'm gonna get that DS or ELSE!!!!! LMAO. Cheers, Tonya

Hi Tonya, I know there are different plans through Medical Mutual, but I encourage you to dig into the 6 month diet thing before you send in info to the insurance and wait a long time for a reply. That is where I made my mistake. I, too was never told about the diet being needed. I was told 5 year weight history, deemed medically necessary, and psych eval. Well, after 2 months of waiting they then sent me a letter wanting more information. My pcp wrote a letter about all the diets I have tried and results of such and made sure again they had notes and weights from last 5 years. Again, I waited for months, even calling them everyday only to be told around the 10th of Dec."sorry you are denied because of not enough documentation of medically supervised diets." So, now I am so mad over all the time I wasted. If I had known about the 6 month diet I would have started it long ago, and been closer to getting approved. Now as it stands I have to do this and then appeal. Good Luck to you, I hope you have better luck with Med Mutual than I have. Hugs, Jane