Medical Mutual Denial

Don't get me started with this company. They approved me in January and I was scheduled for surgery in June. About 2 weeks before my date they sent me a letter saying they wouldn't cover the cost of the surgery or complications due to it after June 30. It really frosted me that they approved it and then turned around and said sorry, but if you can't do it by this date your out of luck. I was able to get my date moved forward a week and haven't had any problems from the surgery, other than I'm losing all this weight. Kirk

I have Medical Mutual Acordia EPO and I am having the same problem. I am going to try and appeal. I have gathered info from when I went to Jenny Craig about 1 year ago and I also have had my PCP write a letter/documents. I hope that it will work. I will keep you posted. Thanks, Marlo

Well just an update. In order for those reports from the weight loss clinic to be considered valid I had to have her name stamped on every page. I also had to include her business card which had "Weight Loss Clinic" written on it. Medical Mutual told me my claim has been sent to an outside source for review. I also notified the State Department of Insurance, they have already sent a letter to Medical Mutual questioning their approval process. Just a heads up if your claim was denied for any other reason than Medical Necessity, you can file a complaint and they will investigate. There is also a company called Maximus CHDR, check the web. They handle appeals once the state has made a decision. Everyone has been wonderful. Alright everybody "Group Hug"