Ok Now I really need everyone's help!!!

Ok, Thanks to all the fine ladies on another thread who gave the me fire to fight this thing. I'm ready to try and give Medical Mutual a fight, but I'm not sure how to get this thing started. Their reason was that my BMI wasn't 2 1/2 times something and that I didn't have 5 years of a medically supervised weight loss plan, but I did supply my weight for the past 5 years. This ticks me off, because I've seen people who have MM and it seemed that they only have to provide that and a couple other things and got okayed. I go to my sleep doctor and am going to try and get a letter from him. I'm supposed to be on a C-PAP, but they won't pay for that either. I'm a big fan of the Cleveland Indians and I notice that MM sponsors stuff like the fireworks that they have after the game alot. That kind of makes me made too. I feel that in the near future they are going to either have to pay for the WLS or surgery on my back. It amazes me that these insurance companies will end up spending oodles of money when you are sick, but they won't spend it (it's our money anyway, isn't it?) to try and maybe eleviate those problems. Being reactive as opposed to being proactive. Well, I think I've vented enough for now.

Thats what you have to do. Dont let them win. And also you need to go thru the Ohio deptment of insurance. They hate claims. It makes them look bad. Thats the way to get your insurance approve. Be a fly on their face at all times. They will want to get rid of you and appove your surgery, To get you out of their hair. Do you have pictures to support you 5 years of being over weight. That is proof also. If your BMI is between 35-and 40 and have 2 co morbities, sleep apnea is one. The secound sound like your back. Have you ever had high blood pressure? Medical mutual paid for my sleep test and cpap. Dont ever give up, I first started in 1999 and gave up. Now I have all kinds of health issues. They want you to give up. Take Care Barb

Tami, I have MM too. I did NOT have the 5 year weight history. I DID have 6 month supervised weight loss attempt. That was the lenght of the weight loss attempt that they required from me. My BMI was 56.4 when I started.....They accepted pictures of me for 5 years. I had 5 years of weights to send them but they were spanning about 12 years. My paper work was submittd toward the end of January. I was told to give them 2 weeks before calling. I called them everyday usually the same time of day. I wrote everything down! The date, time and who I talked to. They should give you your claim ##. I was approved in March and had my surgery on June 1st! If you work with them they will tell you what you need. The last thing that they asked me for was a copy of a photo ID...driver's liscense or passport. I went to Kinko's and copied my driver's liscense and my Sam's card......I had to hide my weight because it sure wasn't what I weighed and I didn't want them to think that I didn't need the surgery so I covered it up with my insurance card....kind of looked like I threw everything on there. But I wasn approved 2 days after they got it! It is a hard road but if you are determined perhaps your doctor would put in a call for you.....I was armed and prepared with everything but the 5 yr. history and thank God I was approved! If you need any help let me know...I will do what I can.... Sue......down 131 total......61 since surgery!

It kind of sounds like the 5 year thing is just a stall for the insurance company to try and make you give up.

Medical Mutual is the most underhanded insurance company I have ever had to deal with for anything. Read their forms and letters carefully. They approve but don't REALLY approve. In my case, they said I qualified, but also in the fine print said telling me that didn't mean I could have the surgery! They then proceeded to change the plan dropping the coverage for gastric bypass without telling me so I could have the surgery before the plan change, then claimed since I hadn't had it yet, I now was not eligible for it...anyway, just stay on top of things and as everyone has said, document, document, document. I wish you well. Maryalice

Tami, On my third appeal with Aetna, they a are very dishonest insurance co. too, I put a copy of the Ohio Insurance Commision complaint form filled out right behind my letter of third level appeal. N0 insurance wants the Ohio Insurance Commision sticking their nose into their business. The Ohio Insurance Commision speaks for us, the consumers, and will get resolution within 30 - 60 days. If you qualified for sleep apnea and they didn't get you the c-pap machine or the mask or allow you to rent the machine from a medical supply company, they have already violated your rights. Also the NHI guidelines for WLS doesn't say 2 and a half times is states a BMI 40 or more. Use the insurance troubles section from "Your Journey" on the Obesity Help[ website. Best wishes. Don't let the *******s get you down! Luann