Medical Mutual of Ohio - Super Med Plus

I have been denied twice, and am currently waiting on my 3rd attempt (2nd appeal). I am borderline weight and just recently found out that I have mild sleep apnea and ventricular tachycardia. Prior to this third attempt, I only had 3 concurrent years of weight having had lost some for a few years but was plenty above weight prior to those "lighter" years. MMO is denying me because I don't have 5 concurrent years of weight. They are not considering that I have been 100 pounds or more overweight 7 out of the last 10 years. I am hoping and praying that this 3rd attempt will prove to be a positive one. For now, all I can do is wait until MMO replies. They have until 12/21/03. I have been trying to have surgery for over a year now. People who I have introduced the surgery to are about to have or have already had the surgery while I still am waiting. If they deny me again, I have no other recourse. I've submitted my sleep apnea results, a letter from my PCP, my Orthopedist and my OB/GYN. Say a prayer for me.

Check your plan/policy thoroughly for this 5 year requirement. As far as I know, there is no scientific reason to deny benefits on that basis. If there is nothing in your plan that states you need 5 years, then appeal on that basis. It's not part of the contract, and it will not hold in court. Fight the good fight! Roberta