MEDICAL MUTUAL SUCKS!! APPEAL DENIED!!

Just heard from Terry at medical reveiw with medical mutual. My appeal was denied. They stated, "there is no true documented failure of non surgical methods of weight reduction, which should include nutritional counseling, behavior modification, a monitored exercise program, and ongoing support." I faxed them 40 pages of weight loss journals, weigh****cher books etc. I now have to file my appeal with the Department of Insurance. This is a bunch of crap!!!!!!!!

Jamie I feel for you! I too have M.M. and am just starting on my road. The nurse told me I have to be on 3-6 month supervised physician diet in the past 2 years which I don't have. And like you I have tired everything. I have M.M. Health Ohio HMO, what do you have. Good luck with your appeals. Do you know about the Law firm in N.Y. who helps people get the insurance to reverse their denials? If not let me know and I will email you their info. Kathy

Did you have you PCP write a letter telling about the diets you have talked about with him, and your weight logged in his notes when you had appointments?? I have MMO Super Med Pluse PPO and didn't have any trouble. You know you can also talk to your HR person. It's up to each company on what they put in each policy. I have heard that your employeer can overturn it somehow and them MMO will pay. You may want to look into that with your HR person. Good Luck, Robin W 11/17/03 218/123.5/115

I too feel your pain!!! I have Aetna. but, besides what Aetna states, my hubby's employer has MORE stipulations on top of that for!!! We have to have TWO YEARS of supervised medical documentation... no Jenny Craig, WW etc... Barix would not even SUBMIT to my insurance because they knew I would be flatly denied!!! I have chosen to go elsewhere and most likely will have to self pay. I can not believe we have to fight so hard to get a procedure that would SAVE the insurance company $$ down the road!! Best of Luck!!! hugs ~Deb

It took me over 2 years to get the surgery, but part of my surgeon's requirements was seeing a nutritionist. By the time I had my information sent in, I had my supervised diet by accident. I had a bigger problem, that my brother, who is a PA with a masters, did my weight and BP around every 6 months, and we kept a chart of it on my computer with his notes. My insurance required a 5 year weight history and I had to fight for THAT. I never even thought that would be a problem, since he was a medical professional. BIG FIGHT to get covered, but with pictures with dates and other proofs, I eventually won.