Medical Mutual

I am wondering if I can get a little help here.  I am Dr. Curry's office manager/insurance specialist.  I have been working with a patient for the past year in trying to get her approved for surgery.  In a typical situation, I have almost no difficulty obtaining approvals, assuming a patient has the benefit.  I have also obtained many approvals, in the past ,from Medical Mutual.  However, for some reason it seems as though they are picking on this one specific patient (I know it sounds crazy, but it's true).  We have everything (trust me, I am aware of their criteria and guidelines).  They simply will just not approve her, regardless of the fact that she does have the benefit!  Has anybody ever encountered this?  Does anybody have any good advice on how to handle this?  I have a game plan in mind, but welcome any advice anyone may have.  Two (or more) heads are better than one!  I want nothing more than for her to be approved. Thanks! Tracy Burch Office Manager Dr. Trace Curry 513-559-1222 [email protected]

Ugh,  Wish I had some advice for you Tracy.  Maybe Gary will have some pointers.  How many appeals have you made to them?

Tracy,  That's a little scarey about trying to get approval from Medical Mutual since that's my insurance company also.  I'm still on the six month doctor supervised diet that they threw at me.  I was on one two years ago, but they said that it had to be a recent diet.  Then they want you to be 100 pounds overweight for five years and that worries me since due to me previous dr diet I was down to 233 for a few months.  At 5'3" I'm not sure if that is 100 pounds ideal.  I have heard other horror stories and do worry about all of the red tape.  I hope that  you are able to get this through. By the way......MM paid last year for orthopedic shoes, but said no to them this year.  They then said they made a mistake last year in approving them!  Go figure!