New here! Info wanted on Med Mutual, Cleve Clinic, etc...

Hello all! I think I'm finally ready to make the plunge.  I've been researching WLS for about 6 months.  Yesterday I finally discussed this with my husband and he was surprisingly supportive.   I've looked at several hospitals/surgeons and I think I've decided on the Cleveland Clinic.  Other choices were Akron City, Akron General or maybe Barix in Groveport.  DH is very concerned about having "elective" surgery and wants me to go to the place with the best reputation so I guess that would be the Clinic. I have Medical Mutual insurance.  Does anyone have any experience with that? About me:  I'm 29 and have always been overweight.  I've tried everything to lose it.  I've done WW, Curves, Atkins, jittery otc pills.  My mom had my Doctor put me on Meridia when I was 17, didn't work.  I have a family history of serious heart issues (G-ma died at 43, dad and both his siblings had cardiac bypasses before 50).  I have a heart murmur.  I know I'm a ticking time bomb and my weight is a serious issue. I have a wonderful husband and a beautiful 9 month old daughter.  My family is wonderful and I hope this surgery will let me be more active in their lives.  Right now I feel a bit disconnected because of my weight and not being able to do as much. I'm currently at 264 according to my doctor's scale and 255 according to mine.  My BMI is 46.  My blood pressure is fine, I don't have diabetes or any other weight related health problems.  I'm just fat.  Will that affect my insurance approval? Any advice, stories, experiences you can share are welcome.  Feel free to send me a private message or add me as a friend.  I look forward to gaining a lot of info here and hopefully losing some weight.   

I have Med Mut and it requires  6 month supervised weight loss.  I did have comorbidities so I didn't have any trouble getting approved. I had my surgery at Akron General.  Have you looked at it's web site for Bariatrics (www.akrongeneral.org)?  We have a wonderful support group and since you are in Hartville the meetings would be easier to get to.  We meet on the 3rd Tuesday each month.  The information session is at 6pm and the support group meets after that.  We have some who have had their surgeries other places, but like coming here.  I know a few people who had their surgeries in Cleveland and they did well.  You just need to find what is best for you!  Good luck in your journey!  There are a lots of us nearby if you need any support or help! Let us know!  There are about 7 of us from this forum who get together - some from Masadonia, Warren, Canfield, Cleveland, Canton and Akron.  Everyone had their surgeries in different hospitals. Would love to meet you!  Watch this forum for the next lunch announcement.  I won't be in town for the meeting in June - going to be on vacation.

Hello I have Medical Mutual and I had some health issues and didnt have any problems getting the surgery approved.  I did go to St. Vincent Charity Hospital in Cleveland.  I did consider the Clinic but I liked the programs and the surgeon at St. V's. The six month supervised diet was the hardest part of the approval. Other than that MM has been pretty good. Being you are so young(im 49) I would have the docs who write the letter to MM hit the family  history big time.  You do need to have some health issues to get approval as far as I remember...but this may or may not apply to you. Best of luck on your exciting new journey.
 

Thanks both of you for your helpful advice about MM. I'm still undecided about a location so any help there is appreciated.  I've heard good things about both Akron and St. V's.  Akron concerns me because they want such a large fee up front that they don't submit to insurance.  I'm not sure about St. V's, do they also charge a "program fee". Question:  Should I go to my PCP to start my medically supervised diet?  Or should that be something my surgeon is in charge of? Does MM have a $ cap?  I read some people's postings that said $10k, but I don't see that anywhere in my paperwork. Thanks! Jen

Each MM Policy is different. Call and find out what yours says.  A lost of insurances do have caps now. Like about 10K. I had MM when I had my WLS in 04 and didn't have any trouble no cap back then either. I called and found out exactly what my policy wanted and needed and was approved in no time. So my advice is to call and find out what yours says and what hospitals and docs are in network and go from there.  Good Luck,  Robin

I had RNY at the Clinic about 2 1/2 years ago and I would choose them again.  One of their surgeons, Dr. Philip Schauer, has a lot of experience w/ this procedure (he's done thousands of RNYs) and I really clicked with him, so the Clinic was a good choice for me.  I also had Medical Mutual and did not have any problems getting approval.  Keep in mind that you'll be dealing with two sets of requirements to get approved.  First, you'll have to comply with your health insurer's requirements to have the procedure covered by your insurance.  Medical Mutual coverage can vary from company to company, so be sure you understand what your company's version of Medical Mutual requires to qualify for surgery.  In other words, my version of Medical Mutual may be different than your version, so make sure you understand what your version of Medical Mutual requires.   Second, you'll have to comply with the Clinic's program guidelines.  They provide a thorough overview of their program in an introductory workshop (or at least they did when I went through their program).  I was required to do a nutrition evaluation and psych. evaluation, along with various other tests (blood work, endoscopy, chest x-ray, etc.).   Good luck on your continuing journey -  Kellie

Congratulations on making this decision! Not meaning to sound like I'm bashing them, and the Cleveland Clinic has a great reputation for many many areas but WLS is not one of them as far as I know. I'm not saying they're horrible or anything but if I were you I wouldn't assume they're great in this area just because they're great in others.  I had my WLS 10 days ago at St. Vincent Charity Hospital in downtown Cleveland. They are 'known' for WLS and the head surgeon actually perfected RNY many years ago. Their statistics are also much lower than the national average. It was my first experience being an inpatient (except for overnight to have babies) and I have to say the nurses and doctors were just incredible! And, I work there too. I'm not just trying to drum up business either - I would have gone elsewhere if their reputation hadn't been as high as it is.  Good luck to you!

hi good luck on ur weight loss journey . i had my surgery at the cleveland clinic by dr schaurer and let me tell u u couldnt be in better hands. as for the previous post the clinic is well knowna nd has great success with wls. dr schauer is the current president of the anerican society of bariatric surgery. the choice is yours to make and the best of luck to u. feel free to email me privately if u have any questions i see we live rally close to one another. i just had to vent about the previous post made aboutchoosing  the place to have ur surgery done. before u post make sure u have ur facts down about all programs and yes to the previous poster u do sound like u r bashing other programs and NO ONE person perfected the gastric by pass. imsure everyone would like to  think that there surgeon perfected the bypass really????

jlmatheo....I have chosen the Cleveland Clinic and Dr. Philip Schauer for my hospital and surgeon of choice, and am happy with my choice.  I do not have Medical Mutual insurance, but if  you need to know anything about the clinc and what they require, you can check out my profile, or send me a message with your questions.  I have given accounts of what I had to do to have my surgery (lap-banding) done there.  I am older than you , but I too am a big person....270 lbs and 5' 8" tall with a BMI of 41, along with a lot of co-morbidities.  I have had heart trouble for 27 yrs, including one heart attack and a triple  heart bypass.  I also have type 2 diabetes and hypertension.  These are some of the reasons why I chose the CC, because of all the experienced doctors and nurses in the various fields, in case something happened to me while on the table.  My husband feels more confident in the CC and Dr. Schauer because of this. I also agree with you, nursekrista35, about the Cleveland Clinic. I did my research on the Clinic and Dr. Schauer, and was very confident that this was where I wanted my surgery done.  I'd recommend that you, jlmatheo, check out the clinic and Dr. Schauer while trying to make your decision.  You just may be amazed at what you find.  I have an appointment with Dr. Schauer this Thursday, and hopefully will get my surgery date soon thereafter.  Good luck in your search and for chosing the WLS and this message board for help and advice.   Susie

Good luck, when i first started my journey a few yrs ago, I had MM, and I didnt have a problem getting approved, I had talked to my pcp before hand about doing a diet so when it said I needed 6m supervised diet, I was already a few steps ahead of myself, I looked into staying in akron or doing it at St V, but opted St V because there was no way I could ever afford that god awful fee (he even makes medicaid patients pay that much, just a side note, if someone on medicaid had that kind of money, they sure heck wouldnt be needing medical assistance ya think, some drs just dont get it though i guess)  anyway,  since I wasnt able to do it then, I have decided to move forward and do it now, and Im still staying with St V I have heard alot of great things about CC as a whole but nothing really about their baractric center, but that doesnt mean its not good ... do your research and pick the one you feel most comfortable with