Need advice for dealing with Insurance Company

I was wanting to know if there are any kind of support groups around the Cincinnati/Dayton Ohio area that helps people with trying to get approval with the insurance company? I have been fighting Medical Mutual of Ohio since February 2004 (it has been a year now). The problem is my BMI is between 39-40 with co-morb. such as high blood pressure (that is not under control) high cholesterol, sleep apnea, heart condition. Everytime they deny me, they keep referring to my BMI not being 40 over the last five years. I have six different doctors that has wrote letters stating this surgery is medically necessary, but they still deny me. I am waiting to hear on my appeal again, but the lady in the member appeals dept. is not very nice. I am sure they will deny me again. They also state that there are no non-surgical weight loss attempts (if they actually read my notes in my chart from my doctor, they will see what diet drugs I have taken over the last 10 years). I don't know what else to do. I am missing alot of work because of my blood pressure. I know that I can hire an attorney to fight this, but I just have a hard time doing that with me knowing that I have all the qualifications to be approved for this surgery. So if anyone has any suggestions, please let me know. I have one more appeal left (if this one gets denied again). Thanks, Michelle

Michelle, I didn't have to deal with Medical Mutal of Ohio but Aetna. Not only did I have to deal with the "normal" requirements by Aetna but where our insurance is at, my husband's employer, they had additional requirements. Even though I felt I met the requirements, where I initially went for my first surgical consult refused to submit my information stating I had not met them. I, obviously, could not fight the insurance company until it had been submitted. So, I sought out and found another surgeon (thank goodness I did too!) who stated submitting would not be a problem. Sure enough, after my paperwork was submitted, I was denied. Each and every single time I would call for information about what was needed and/or to point out I had that requirement fulfilled, I would get a different response. They were driving me CRAZY! Finally, I had had enough. I got a hold of a gal and told her to TELL me the requirements but ONLY after I had a hard copy of them in my hand. So, when she started telling me I need blah, blah, blah, and I couldn't find it in the requirements, I told her to tell me where that could be found in the written requirements and when she couldn't she documented that in my file-or at least so she said but I do know they would never tell me that again as a requirement. Then when they said I hadn't fulfilled a requirement I would point out where in the doc's notes it stated I had fulfilled them and they, supposedly noted that in my file. Long story short, they will give you the run around as long as you let them and not until you put your foot down, will they even begin to listen to you. YOU have to take charge and let them know you have had enough. I even threatened to report them to the State Department of Insurance because of all the run arounds and mis-information they had given me. My recommendation would be to sit down and make them tell you what they want. If you have it, point that out to them. Make them tell you what you lack and then see if one of the docs can help you in their letter to further document the medical necessity. Don't give up-pester them and make them tell you what is needed to GET approved! And if you have it, SHOW them its there! Beth