Insurance denial Medical Mutual Super Med Plus

I am heated, I have always played by the rules. I kept an insurance carrier United Health Care who had a written exclusion with my employer. They did not treat obesity but because my children's pediatrician was with this company I stayed, he is excellent and I did not want to lose him. Besides I thought I could lose the weight. Now they are grown and I am larger than when I started. I switched insurance companies as everyone else has done to have this surgery. What did I get, A BIG FAT DENIAL. I was told I did not have enough information regarding supervised dieting. What a crock. I can easily change PCP and get a doctor to say what I want him to say because I do have other visible problems. But no I try to do it the honest way. My doctor would not hear of it, that is obesity related complaints so why waste her time and mine. However I do respect her. The type of work I am in I see a lot of medical fraud. So exercise and dieting on my own were my only resort I must admit I was successful but recently there have been some traumatic life changes and the weight has returned. I wrote a letter of appeal to Medical Mutual of Ohio Super Med Plus but it appears they want me to doctor hop, you know find one who agrees with them, what a bunch of idiots. I have supplied them with my diet history and notes from the weight loss center I did attend. I had to pay $2000 out of my pocket to this center. Honesty gets you no where. My BMI has been over 40 for 10 years and most recently over 50. I have extensive swelling in my lower extremities and I put off going to a specialist because I thought I would be having WLS. I think now I will start spending some of their money. Make up crap and see a specialist. Give them what they want, personally they can kiss where the sun does not shine, but rest assured they have not heard the last of me

Martha, That is a really sad story. I hate to hear that. As a Bariatric Coordinator, I hear alot of it. I hate to come off on this forum sounding like I am plugging the use of Gary Viscio, but he just really helps in situations like this. I have found, unfortunately, in the past that you have a limited number of appeals (usually 1-2) before the insurance companies will no longer hear your appeal. I hate to waste this for our patients, so I usually refer them to Gary who is an obesity advocacy attorney in NY with whom you have no doubt heard of through this website. He has really proven invaluable to our patients. There have been denials which were so steadfast with our patients that he has been able to hammer through - even Cigna and Aetna, which to those of us in the Bariatric Surgery world are the bain of our existence. They are ridiculous with their MD supervised dietary history. This is no commercial - I am just saying that I recommend you and anyone who is having problems with insurance companies saying "no" - to check Gary out at www.obesitylawyers.com. He has an e-mail contact form and is really good at returning e-mails. He is a compassionate man whom has undergone the surgery himself and is truly understanding. I can't thank him enough for what he has done for our patients. We operate Friday on a young lady with Aetna who had lost all hope after two denials. Gary stepped in and caught Aetna in a lie and her denial was overturned within 24 hours. Go Gary!! Best of luck and I hope everything works out for you. Marcie - Bariatric Coordinator Obesity Surgery Center of Louisiana www.obesitysurgeryLA.com