Medical Mutual of Ohio Super Med Plus

-------------------------------------------------------------------------------- ObesityHelp.com Profile Update - CONFIRMATION 09/21/04 -------------------------------------------------------------------------------- MARTHA JETER [email protected] Member ID is J1085597819 View Your Profile Profile Comments Changes: I am 5'4" with a BMI of 50 that is easier to say than the actual weight. So far Medical Mutual of Ohio SuperMed Plus has been stalling. At first they said they needed a weight from 1999 despite having proof (a recorded weight) that I was much more than 100 plus pounds overweight on January 28, 2000. I cleared that up by telling them to use a little common sense. Then they claimed I did not have clinical documentation of non-surgical supervised weight loss attempts. I explained this was not possible because my previous insurance carrier did not permit treatment for obesity. I had a thyroid study done once and because my physician put obesity somewhere on the paperwork the insurance company would not pay the office bill or for the lab work. I joined a weight loss clinic 1/28/00 that was supervised by a doctor and went from 300.6 to 252 in five months. I took a break from the clinic during the summer months. When I returned in the fall I weighed 251. I took up bike riding, I did this everyday. My weight stayed under 270 for 3 years. I have the recorded weights to prove it. I presented this to the insurance company to show I must have been involved in some sort of physical activity. It may not have been supervised but I was MOVING. Around the fall of 2003, my finances were ruined so being picky about I ate was of no concern, all that mattered was that it food. So here I sit, 300 pounds plus, doing all of this typing has given me courage to actually type it. LOL. Trust me, they have not heard the last of me. If I have to actually drive to their office in Cleveland I will. But so far I have faxed, written and e-mailed so many times until when I was finally able to talk to a LIVE PERSON in member appeals she said she recognized my name. This probably would have been different had my physician written a letter of medical necessity. She is neither for or against the surgery. I respect her, she is good at what she does. More than likely I could find another PCP who would write one but I don't like this game playing. My co-morbidities are heel spurs, umbilical hernia the size of an orange, knee pain, shortness of breath and swelling so severe in my legs I need to wear Jobst Stockings. My physician is aware of these problems and she and I both know I could make appointments with a podiatrist, orthopedist and surgeon for more additional documentation but as I said to the insurance company these are all obesity related ailments that can get better with permanent weight loss. So why waste time and money when the proof is already in file. Maybe I should start spending their money for all of these studies??? It may get their attention, maybe even a sleep study. So far Medical Mutual has been difficult. Will keep everyone posted --------------------------------------------------------------------------------

You better spend the insurance's money on every test you can get done, including a sleep apnea test. It's wise to know a head of time if you have sleep apnea and need a CPAP machine as you'll need it when you go in for your WLS. I'm glad I had all the tests done that I had done because every single Doctor is behind me on getting my WLS. My PCP, vascular Doctor and my pulmonary Doctor and lets not forget my surgeon "Dr. Koren" I go to my Doctors ALL the time with my medical problems so they are documented proof that I'm having these problems. Donna