MedMutual Ins - Ohio

Does anyone know if MedMutual will approve for surgery?  I work for a Nursing Home and that is my primary insurance and per an email I received from them last any type of weight loss surgery is excluded (sigh).   Is there any hope?   Should I even continue my quest? Sher

Yes they do overturn denials on appeal.  Keep up on them.   When did the exclusion go into effect?  They were covering this for a while.

My BF has MM and rny was covered.  Then 4 yrs ago he was going thru the process and was told no they no longer covered it.  It says now in his handbook from MM  " Does not cover weightloss surgery or complication."  Do you think there is any hope for approval?   Thanks...

I started with the nursing home a little over 3 years ago and apparently they changed the insurance not long before I started. Sher

If Medical Mutual is not paying for any kind of weight loss surgery, then it must be because it is an exclusion in your particular policy.  I have MM and they have a list of requirements that must be met (psych consult, six month diet, 5 year weight loss history documented by doctor notes), but surgery is a covered option for a diagnosis of morbid obesity.  Good luck!

Well the saga continues !  My doctor did write a letter to MedMutual Predetermination dept last week, not sure what will become of that.  But I sent an email yesterday to OSU Medical down in Columbus to get paperwork so I could start that process .. this is my response today: ============

Ms. XXXXX

 

Thank you for your email and your interest in bariatric surgery at The Ohio State University Medical Center.  Unfortunately, we have found that if a procedure is excluded from your plan, submitting medical necessity will still not typically be grounds for approval from your insurance company. 

 

We do have a self-pay option, which I would be happy to share if you are interested in learning more.

 

Thank you again for your interest in our program.

 

Program Director

 

OSU Bariatric Surgery Program ================ So .. even though I'm trying to get my insurance to "include" me on my work policy (I've even sent a letter to our Executive Director here at work to see if he could speak to the insurance people).     I just want to go home and cry ... at least go home and just crawl into bed till the alarm goes off in the morning for work :(  (sigh) Sher

OK ... it's now 2008 (March) and I'm hoping someone can help.  I still work for the nursing home - they STILL have any type of weight loss surgery excluded from the policy (as does my husbands).  Is there any hope of getting that overturned ? My sister has had her 2nd surgery in 18 years ... my boss just had a VSG surgery but she paid for it privately.  I can't afford that :( Sher/Ohio