Medical Mutual Question

I was wondering if anyone has delt with MM of Ohio and not had 5 years worth of 100+lbs over weight. I have been talking to Tracy and she is wonderful. She has answered all of my questions. She said you can appeal and normally they will appove, but I was just wondering if anyone has had to appeal with them and how did it go. Thank You for your help ~Kim~

I have Med Mutual Ohio PERS and I didn't have a five year history. I think I was missing the first year. I talked to them because I was concerned that I would get a denial. I person I talked to assured me that medical neccessity would be the first consideration. Sure enough, they approved the surgery with no problem. Just make sure you are going to an in-network provider. Barix treament center wouldn't do mine because Med Mut was sending the pymt to the subscriber instead of them, because they weren't in-network. I really think it's just a power play to get Barix in their network provider web. I ended up having to find another surgeon. The approval just transefered to him, thank goodness.

Hi Kim! I honestly believe it depends who's desk your paperwork hits. Medical Mutual leaves a very bitter taste in my mouth. I tried for approval in 2002. In 1999 I had a bmi of 39, so denied. Tried again in 2005. My doctor's office never recorded a weight for the entire year of 2004. Turned in my Weigh****chers at work booklet for 2004 and wedding pictures from that year (I could prove the date of the photos). Still denied. Appealed, then they said they would consider my claim again IF I did a six month physician supervised diet. Forget it. They've had me jumping through their hoops for 4 years. I'm a self pay now. I will have DS on March 6th. I have friends that were either missing a year of recorded weight and/or had a year of low bmi and bingo...they got approved. Same employer, same policy. Go figure. All I can say, is don't give up and use all of your appeals. I'll keep my fingers crossed for you that you won't have to appeal. Good luck! Diane

I had Med Mutual, SuperMed Plus. I had everything they asked for, except for 6 consecutive months of medically supervised weight loss attempt. I appealed, denied. Even though I tried many different programs, because I didn't have medical supervision, I was denied. I really hope that you can get approved!

Hello Kim, My name is Richard Wilson and I had Medical Mutual. I live in Marion and as you can see by my profile that I have already had surgery. I also have a bitter taste in my mouth with Meducal Mutual. Judt didnt like the way they do things. I am the manager at Goodwill and would be happy to talk to you anytime. Come out and see me at the one across from Walmart. Good Luck! Richard

Kim, I had Med Mutual as well. I was denied originally because of not having 6 months of clinical weight loss attempts. I immediatally started to get my diet supervised by my PCP. After about 5 months my surgeon resubmitted to them with an appeal. They contacted my PCP to question her. She ended up getting into a verbal "discussion" with the woman from MM. Ended up hanging up on the woman from MM. The next week i received a letter stating that my original denial had been overturned. This is according to my PCP. They had every intention of denieing my appeal i believe. What made them change their mind? I will never know. I do thank God every day for their change of heart and my PCP sticking up for me. If i can help in any way let me know. Good luck.

Kim, I personally that that MM of hard to deal with. They denied me for a year and a half. So I hired an attorney (Gary Vicio) and he done my appeal and it was overturned. I had my surgery 9 months ago. They will make up jump thru hoops and then want more information from you. Good Luck and don't give up trying to get approved. That is what they want you to do, is give up.

Kim, Yes! I did NOT have the 5 year weight history. I sent them pictures of me.....with a granddaughter so you could see her growing. Even offered to send them a copy of her birth certificate. They didn't need it though and was approved in about 2 weeks of the pictures...and then a follow picture ID. Good luck! I called them every day and bugged them! Don't hesitate to call and find out the status of your claim! email me if you need more information! Sue 320/132/130 goal!

Hi Kim, I am currently a Medical Mutual carrier too. Like everyone else, they leave a bitter taste in my mouth as well. I began last April 05 to have WLS with Barix Surgery Center in Grovesport Ohio. I didn't have five years weight loss history with a known provider (Weigh****cher or Jenny Craig, so on and so forth). I had to go to my doc once month for a weigh in. To make a long story short. I sent in the weight loss record with 5 pictures of me. They approved my surgery but not the doc or the hospital. They consider it out of network. They said that they would only pay 60 %/ 60% with their approval for that. That just about blew me away because we I began this the doc and the facility was in their network. Come to find out that they had dropped Barix Center. That they would only pay for a level one surgeon and facility. So I ended up going to Dayton. The facility (for the moment) Kettering is in their network, along with the new doc. All I can say is hang in there. Keep pleading your case to show that your serious about this and you'll get approved as well.

I went thru the same thing. same place. Had to change Drs and everything. I have same insurance as well. I am glad the pictures worked for you. I had my 5 years . They put a bitter taste in my month to. But now I am thankful to them. Did you do the 6 month diet? Take Care barb