Medical Mutual 2nd Denial

Well on to the arbitrator, which I am glad. Now hold on everybody, I actually found this entertaining. I was initially denied for only ONE reason and it was "Non-surgical supervised weight loss attempts." I supplied them with my diet history from a MEDICALLY SUPERVISED PROGRAM WITH 6 MONTHS OF MONTHLY WEIGH INS AND ANOTHER WEIGH IN 6 MONTHS LATER TO SHOW I HAD MAINTAINED THE LOSS. The loss still did not achieve a BMI of less than 40. Now the denial at appeals level is based on "Drum-Roll" please 1. No documented history of morbid obesity for 5 years. I supplied 4 years, my 99 weight was stored in another chart off site but on 1/28/00 my recorded weight was 300 plus. 2. No true independent documentation of failures of non-surgical methods of weight reduction. 3. No documentation that individual has received counseling regarding post operative cosmetic difficulties. Define independent MMOH!!! I was told Weigh****chers and other programs were not acceptable. The Weight Loss Clinic was independent and supervised by an MD, I paid for it. The hospitals will not schedule post operative counseling until your insurance is approved. I had already involved the State Department of Insurance, so now they will take over. Talk about word games. There is one thing I have always wondered concerning Medical Mutual SuperMed Plus. There guidelines for weight loss surgery cannot be found in writing. I have gone over there Web site, health plan book, pamphlets and nothing. Maybe I'm wrong, but this gives them the upper hand to change the rules to their advantage. I have made the Ohio Department of Insurance aware of this fact. You will always win, if your opponent is blind. Come on Ohio Med, lets play fair.

Martha, I feel the same way about Medical Mutual. They jerked me around also. I cannot appeal anymore. Can you? I provided them with what they needed everytime that I got denied, and they just came up with more reasons to deny. I also filed a complaint with the Department of Insurance, they did not do me any good. Maybe they can help you. Also, you cannot re-submit for a new claim until six months after your previous claim was denied. That is what I was told. Check on that. Good Luck! Michelle

Have you contacted Walter Lindstrom? I can't remember if you said you had in your prior posts regarding this. He may be able to help you. It sounds like you have all of the information you need. do you have co-morbidities that could help your case? I hope you win this Martha. You have certainly fought hard enough for it. ~~jaimee

I was denied the first time and MMO is playing games I think. Barix is still waiting for a call from the insurance rep. If I may ask, who is Walter Lindstrom? I'll tell you what, I'm really getting tired of medical insurance companies. Boy, they don't hesitate to take your money, but when it comes to helping you in the long run, sorry 'bout your luck. Tami

Tami, Walter Lindstrom is a lawyer specializing in Obesity law. He fights insurance appeals. I believe he offers several options of varying cost. I had heard some say it could be as little as a couple hundred dollard to hire him. See: obesitylaw.com He is someone who has personally experienced our struggle and approaches things from that perspective according to his bio.

I wish you good luck, my sister was turned down too but chose not to fight. I feel really bad for her but cannot urge what she does not feel comfortable doing. They have changed so much in the two years(tomorrow) since I had my surgery that it seems like a different company altogether. Again good luck and good wishes, keep us up to date. Darla

I have MedMutual Super Med Plus and was approved withing 48 hours of them receiving everything they requested: five year weight history listing all attempts to lose, letter of support from my PCP (she also supplied some xrays of joint-related pain in ankles and back, even though the initial injuries were not weight related), and a letter of support from my therapist (I was being treated for a mild case of depression at the time). My total out of pocket costs were $350. They picked up the rest. I had it at BTC/Barix in Groveport...it will be three years in November. ...Mary