Denied

Hi Tami, I feel for you, I really do. Med Mutual has joined the likes of pretty much all the insurance companies out there.....THEY SUCK!!!!!!!!!!!!!! Med Mutual used to have such a great reputation when it came to wls, but as I have found out in my own experiences, there is no limit to how far they will go to deny (you cab read my profile for my whole story). Let me give you a heads up. They pull out all the punches when the denial process is started such as disclosing to you after the fact that they have a whole other set of guidelines (if you so happen to meet the first) that they like to call Medical Mutual Corporate Medical Policy. Sounded & smelled completely like fraud to me! I will also tell you that they won't care one bit about your back problems, swollen ankles & disturbed sleep. They will not look at those as co morbidities. I had a whole list of the things that I suffered form & Diane Tonkin-collins (Appeals Cordinator) shot em down. Get some ammo by going for a sleep study to prove that you have sleep apnea (as your symptoms indicate that you do). Have you had your levels checked lately for things like sugar, cholesterol & tryglcerides? If not, go & have that done too before you send your appeal. I would like to say that yes, they just deny everyone first time around & then have a better reputation for approving after the denials, but that just hasn't been my experience & unfortunately, it doesn't seem like that for others either. You must continue to fight though, don't give up! Good luck to you & if I can be of any assistance, let me know. Jen P.S. You mentioned that you can never get a hold of anyone...I have never had that happen. Try these 2 numbers: 800-585-2583 follow the prompts & when someone finally comes on, tell them your a patient not a provider 800-362-1279 this is the customer service # so I'm not sure if you are using this one but keep trying.

Tami, Dont feel bad, I got the same response and my first denial yesterday. My BMI is 36.5, and I have reflux, severe knee and back pain, and I have trouble sleeping. I weight 218 pounds and need this surgery, but they deem it "not medically necessary". I have Anthem BCBS and when I called to see what hoops I had to jump thru she just said to appeal it. So this is my new journey. I will say a prayer for you if you say a prayer for me. We are in the same boat, but I am about to jump off. Chelle Monroe, Ohio