insurance denied....appeal letter help!

Help! I need to help! Medical Mutual has denied surgery. They said...no documented weight loss attempt! My PCP apparently didn't document my weight loss attempt in my file....now I have to start all over again! Also I didn't go to the doctor every single year so there is no weight recoreded every year. He did go back and recorded 5 years of weights starting in 1992 and I still my BMI was over 45.....any help would be appreciated! I have so many co-morbids and they are paying over $800 a month to keep me in this shape....why won't they realize that it would be cost effective for me to have the surgery and get rid of the meds and the cpap machine! Sue

Sue, I understand where you are coming from with Medical Mutual. I have been trying to get approval with them for almost a year now. I believe that they put that statement on every denial "no documentation of non-surgical weight loss attempts". They put that on my denials everytime. From the first time my information was ever submitted to them, they had copies of my notes that my doctor had wrote in my chart of every medicine that he prescribed for me and how much weight I lost. Just dont give up. Is this your first denial from them?

Ask to see the copy of the letter your PCP wrote. It could be that he just didn't write it the way MMO wanted. If you go to my profile page you can see the copy of the letter I wrote. It was almost the same as what my PCP wrote. I also think MMO is denieing just to see who will fight back and who will quite. I had MMO with my surgery and got approved it 18 days. I made sure I sent in everything they wanted. Good Luck, Robin W 11/17/03 218/115 45.6/24 26w/4 petite

Thanks for the help! I will see what will work. I am not giving up. My health is too important to me to quit now! Sue