It's official... I'm APPROVED by MMOH for RNY!!!

I can't believe it!!!! I just received the official letter in the mail from Medical Mutual of Ohio stating that I am approved for RNY Gastric Bypass surgery out of "Medical Necessity"!!!! I originally sent in the packet last Fall under Dr. Viglianco at the Barix Center in Groveport, and had since found out that they are not only not in-network, they are not even considered a "first-tier" provider! So, I recently decided to switch docs to someone in network to save on my out-of-pocket expenses. I came to choose Dr. J. Wesley Alexander from UC to perform my surgery, as he came highly recommended by my own PCP and other's that I have talked to that have had the RNY while under his care. He seems to be very highly respected amongst others in the profession, as well. He operates at Christ Hospital, and both he and the hospital are covered at full benefit amount, as they are both in my network. Following my meeting with Dr. Alexander, I met his secretary, Nancy, she stated that I would have to go through pre-cert all over again!!!!! (Even though I am approved?!?). So, I decided to call MMOH to find out what to expect and they stated: ... that I am approved based on Medical Necessity and that the new doc doesn't even have to contact them to get anything "switched over". The hard part will be convincing Nancy, as she has been arguing with me every time that I question it, that it all has to go back through pre-cert!!!!!!!!!!!!! My insurance company stated that I could have the surgery tomorrow and it would be paid in full at full benefit amount!!!!! With no need for anything else to be done, or anyone else to be contacted.... they are now just waiting on the bills to arrive post-surgery!!! Following my conversation with MMOH, I tried calling Nancy back and wound up having to leave a message for her to call me. I tried to explain it all again on the voice mail, and gave her the 1-800# for provider information so that they could try to explain it, as well!!! I know that she is incredibly busy, but, she seems to be pretty short on the phone and I really feel like I am bothering her when I call. So, I really hate calling and disturbing her, but, OMG, I don't want to have to wait any longer for surgery.... I AM READY!!!!! I had my nutrition class last night at Christ Hospital and I can't wait to get started. It was a very good class and I really want a surgery date!!!!!!!!!!!!!!!!!!!!!! If Nancy were to call back today with an opening tomorrow, I'd jump through any hoop just to make it happen!!! It's funny, I only thought that I was going nuts waiting for an approval.... Now that I know it is possible, I'm getting extremely impatient and want it NOW!!!! I know that this is an incredibly long post.... so, thank you to those who "stuck it out" with me in order to get to this point! Any comments or suggestions would be greatly appreciated..... .... as, I can't wait to be on the losing side!!! hugs, hugs, hugs, Karen G.

Karen, I am doing the happy dance for ya!!! Yes, I am very clumsy, so that noise you heard was me clomping around. congratulations!!! Cheryl

Karen, Congatulations! MM approved me on 3/30 and I have my date. It's 6/1! It is kind of it was anti-climatic after I found out everything! You work so hard and jump through so many hoops to get to approval and then you wait and wait! We will both be big losers very soon! Sue

Congratulations on your approval!!!! Getting to the actual surgery date seems to be the hardest part! I have learned quickly that I an NOT a patient person. I am still in the 3 month medically supervised weight loss program and still have the psych eval, medical record gathering, etc.. still to do. I feel like it will never get here. It is so encouraging to see that your patience and persistence has paid off. Good luck!! Shellie

WAY TO GO KAREN!!!!! Hillsboro will NOT know what to do with the 2 of us on the lossing side!!! Getting spproved by MMOH is a HUGE accomplishment!!! I am so happy for you and the next time I see you in Walmart I may just have to tackle you to give you a hug!!! by the way, I just emailed you yesterday!! Liz

WOOOOOOOOOHOOOOOOOOOOOOOOOOO ,,, YESSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS,,, What a good day it is for you Karen. Now dont let this Nancy get you down. Enjoy the feeling of being approve. Hugs Jackie C

congrats Karen! You are right, it is a big waiting game. I have 5 more days until my surgery and I'm becoming a basket case!

Karen, first congratulations on getting approved and finding a surgeon and program you are happy with. I got approved and then changed doctors and the surgeon's office I switched to only had to make a phone call to get the approval switched. Not the same insurance company, but similar experience. Too bad that this Nancy can't be a little more supportive since she must know that everyone that is trying to get approved is very anxious to have the surgery. Good luck and keep us posted. Chris

YAY!! Congratulations!! You must be soo happy, I know how it is to wait...I'm still waiting...but I love seeing everyone get approved because I know my day will come too!! ~Tema

Congratulations Karen on your approval.....I'm glad it finally came for you!! It seems it takes forever, believe me I know!! Please keep us updated on your surgery date and hopefully you'll hear something positive from Nancy today!! Tabitha