Help!

I have Medical Mutual Super Med Plus and I too have been denied approval. I have Walter Lindstrom, obesitylaw.com, working on this for me, but I am starting to lose faith, as it seems so many with Medical Mutual Super Med Plus have also been denied. Is there anyone out there that was approved by Medical Mutual Super Med Plus? I would like to regain my faith. I do have a chance to sign up for United Healthcare in November to take effect in January 2005. Does anyone know if they cover the surgery, or do they play the same game? On top, the surgeon I am going with, effective 12/1/04, will no longer except Medical Mutual Super Med Plus, as they pay them less than Medicare and they are no longer going to except it. He didn't seem too concerned about this as he seems to think that something could be worked out by 12/1/04, but it seems like I am hitting alot blocks. Does this happen alot or is someone trying to tell me something? I want to do this sooooooo bad. I want to have engery to do things with my grandchildren and live life to the fullest, which I can not do at this time. Thanks for listening. I have not posted very often, but I am a faithful reader. I enjoy all of you and thank you for all your comments and help. Cindy

Cindy, I know how you feel. I was denied by Medical Mutual Acordia. I was told that you can get approved but they are making it harder. My case worker just told me that today. It sounds like you are doing everything you can. Good Luck with everything and I hope that you get approved. Don't loose faith and don't give up. I was also told that the insurance company wants you to fight for it. So, I would call them an complain and plead your case. Marlo

I'm sorry your having such a hard time with MMO. I have MMO and didn't have any trouble getting approved. I called and ask them what it takes for med. necessity. All they wanted was: 5 year weight history, one from you, one from your PCP, psych. evaluation, letter from PCP stating medically necessary, BMI of 40 or higher and/or at least 100 lbs. over weight. My paper work was sent to MMO on 9/22/03. Entered into there system on 9/24/03. Went to Physicians Review 10/1/03. APPROVED 10/10/03. Total time about 18 days. I know the rules have changed a lot in a year but keep up the faith. Good luck, Robin W 11/17/03 218/115/115

I have uch ppo and I didn't have any trouble getting approved at all, except for them losing my paperwork, however I let the Barix handle everything and once I found out that they uhc, had lost my paperwork I called Barix and told them and they faxed everything again and I was approved in less than a week. My suggestion to you is once things are sent in check with the insurance co. once a week at least to see where everything is, status wise-that way you will know if something gets lost. Good luck to you on your journey.

Cindy, I am so sorry you are having such a difficult time getting approved. I have MMO Supermed Plus and I was approved, but not without a fight. I found back doors to push things through. My surgery date was changed to Nov. 29th because of the surgeon not being in contract with MMO after 12/1. I understand your frustration. I do know MMO is making it harder and harder to get the coverage. I hear UHC can be just as bad. Most insurance carriers are difficult. The key is being persistent. You can always appeal with the State insurance commission if you need to. Hang in there. If I can be of help in any way, just say the word. Hugs, Jaimee

Jaimee & Cindy, I have MMO Super Med Plus, I am now waiting on approval. All these horror stories are starting to get me down. However, I have put it in god's hands so we shall see. Jaimee what are some of the back doors? Do you have any suggestions of what we could do. Also, did you have all your paperwork up front to them, Cindy did you? God Bless Jackie C

Jackie C, Yes I had everything. 5 year weight loss history and more, proof from a physician that I tryed Meds for weight loss under his supervision, letter from my primary doctor stating 7 co-morbidies and all the reasons they felt I needed this done, pysch evaluation, had a stress test, had my sleep apena testing done (which I have severe sleep apena and I am now on a bipap machine), went to a counselor, I'm 125 pds over weight, BMI of 42, everything they could ask for. My lawyer sent a 25 page letter as to why they should approve and they denied. About 17 days ago they sent paperwork to the Board of Trustees, which I have not heard anything yet. I am going to the same place as Jaimee and I am afraid if something doesn't happen soon, I will not have the surgery with them even if I would get approved, as they are no longer excepting Medical Mutual Super Med Plus as of 12/1/04 and I would either have to go somewhere else and start all over or get a new Insurance Company and start all over. If I could get approval soon I think they might try to get me in before 12/1/04, but too much longer, I'm sure they won't. Before I started the process I heard that all paperwork has to be in order and I did my best. Hopefully it will work out and I will hear something soon. I just don't understand sometimes how they do cover for some people and deny others. I also know of someone my husband works with that had it done under this plan. I don't understand??? All I can do is pray and receive all the prayers and good thoughts from all of you. I appreciate all the concern and help everyone gives. It sure is a big help. Cindy

Goodness, this is so crazy. You would think they would get tired of paying out for all the test and medicines. In the long run it would be cheaper to have the surgery. I hope we all here good news. I will pray and plea the blood. : ) You have a great day, and God Bless Jackie

Hi Jackie, Don't give up just yet. I know this process can be discouraging but you need to fight. This is your health and if you are set on having this done, you'll find a way to do it. I had several things I did to help me get approved. First, if your employers HR people can give you the direct phone number to the person that handles their account at the insurance company, it would be good to obtain it. I did this and found that the girl *****presented my hubbies employer was very helpful. I asked her to manage my case. She kept me informed on the status of things ( even gave me a heads up when a letter was being sent out to me) and even pulled some strings for me to make sure I was approved in time to have my surgery this year. If your company's rep is not willing to do this, request a case manager. Most insurance companies have people who handle this. If you have an advocate on the inside, it is a valuable tool. Be sure not to be too pushy or nag them by calling too much though. That can go against you. I made it clear to the girl I was working with that I wouldn't be a pest if she called me once a week and updated me on my status. This worked well.] Also, give them MORE than they are requesting from you. Go armed with personal letters from friends and family describing the struggle you have hgad with your weight, copies of the covers of diet books you have purchased, copies of the covers of exercise videos, pictures of any evercise equipment you own, photocopies of gym enrollment forms, weightloss center records, etc. Send pictures of you looking very uncomfortable. If you get yeast infections in your skin folds, take pictures and include them. Describe any difficulty you may experience with personal hygine. Write your own personal letter. Avoid being too emotional. Give them the facts, spell out the long-term costs to the insurance industry if your health doesn't improve or declines. Be sure to describe the effect this has on your family. Get copies of every medical record you can that has any discussion of your weight problem. Highlight those sections of the records in yellow so that they stand out. Where it tells your statistics on each Dr. visit, highlight that too and underline it with a red ballpoint pen. All of htese things can work to your benefit. Unfortunately when you are trying to get approval from the insurance company you have to be a salesman. You have to convince them that this is going to benefit them in some way. They are in business to make money and the last thing they want to do is pay for expensive surgery. If you red flag for them all the possible costs it they could have by not treating this, they are more likely to do so. If you have been with them for any length of time and are able to show how much it has already cost them, it could help too. I have always tried to be studioud with my insurance and avoided going to the doctor unless I was extremely ill. I learned my lesson from this, since I hadn't gone, I didn't have a paper trail to prove much, when I realized I was being penalized for not going to the doctor all of these years, I started going for every little ache and pain, I think it helped put things in perspective for my insurer. It's sad that it had to be this way, but it is very true. I hope this helps. If I can help you in any way or if you have more questions, please send me an e-mail. Best wishes to you on this journey! Hugs, Jaimee

Jaimee, Thank you very much for the information. If I have to appeal, It will be very useful. I have already sent them what they said they needed : ) but you know the story behind that, right... *laughs* As for the HR person at my husbands work. I will try to get ahold of him. Again, I thank you for taking the time out to answer my question Jackie C.