Just keeps getting worse.....
I had left a message with my PCP about an appeal letter. Well, he called me back this morning and said that there seemed to be nothing more that he could do. 
because the denial letter said that I my BMI had to be 2.5 times my ideal body weight, which he told me would put me at about 350. What I don't get is that if that's what they want that would put my BMI at 50. I thought that the standard was 40 without co-morbids and about 35 with co-morbids. I think Tuesday I'll fax my packet to the insurance company with an appeal letter of my own. Should I call them first and tell them that I want an internal review before I fax it, after? Then I believe that the Department of Ohio Insurance wants you to go through that then an external review. Should I include a copy of a the complaint form also, just to give them a nudge? This is making me 
and 
. I wonder if things would be different if I'd gone through the surgeon first and let them help with the paperwork and not been trying to do this myself? I've done nothing by cry and even got into an argument with someone at work.
because the denial letter said that I my BMI had to be 2.5 times my ideal body weight, which he told me would put me at about 350. What I don't get is that if that's what they want that would put my BMI at 50. I thought that the standard was 40 without co-morbids and about 35 with co-morbids. I think Tuesday I'll fax my packet to the insurance company with an appeal letter of my own. Should I call them first and tell them that I want an internal review before I fax it, after? Then I believe that the Department of Ohio Insurance wants you to go through that then an external review. Should I include a copy of a the complaint form also, just to give them a nudge? This is making me and . I wonder if things would be different if I'd gone through the surgeon first and let them help with the paperwork and not been trying to do this myself? I've done nothing by cry and even got into an argument with someone at work. 
Was this Ohio Medicaid? Do you have any co morbities? I am waiting for an approval or denial from Medicaid...How long did you wait from the time the papers were sent till the denial? I would go to the doctor and have them do an exam and blood tests and include that with the paperwork showing that (if you have) your health is getting worse...More aches and pains, more fatigue etc...That couldn't hurt. Just to show them that if something isn't done you will go down hill more and more...
When I battled MM, after my denial and subsequent denial on appeal, I sent them a letter myself. I spelled out all of my problems in great detail and I asked for an indepndent review, which is their policy. However, they always review claims internally before sending them out. The thing to do is send everything you have, including any update letters from your doctors and spell it all out for them. You have to show them it is cost effective and most of all that you're not going to give up.
Hope this helps-
Sharyn
Just send in a copy of the original letter. Also, copies of any subsequent office visits. I forgot to mention before, if you don't have any comorbidities, you may have a tough time, but it isn't impossible. The more you have, the more likely they will reverse thier decision without sending it out, like in my case.
If you read my profile, you will see that I had Medical Mutual super med plus. They fought me and then some. I filed a complaint with the state and so did my doctor. They will fight till the end. Just dont give up. If I am not mistaken in Ohio if it is considered Medically neccessary and they do not have an exclusion on the policy, they can not deny. They might try to put irons in the fire like me and say you need "ongoing Therapy" for an eating disorder. Whatever! We all have reasons for why we are overweight. Just file your complaint and then do what they ask. Once I started therapy and complained, they approved. Then I stopped therapy. It just took a month longer. GOod Luck! Richard
gosh, now you guys are scaring me, i too have mm supermed plus, and im trying to get my stuff together to be sent out, i just went for my consult and was told that i needed a 5 yr weight history, with progress notes, well why dont they tell you that to begin with (all mm told me was the 5 yr history, so i had gotten that, but the insurance lady just told me about the progress notes) she also said that MM wont approve unless ive been 40+ bmi for the past 5 yrs also .. but i have to get some documentation together which is such a pita .. and i need to get documentation of a supervised diet with my pcp or else im gonna need to
see a dietician or join like ww or something similar..
good luck
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