Medical Mutual Insurance

I have Medical Mutual Insurance of Ohio (SuperMed Plus) and I was denied several times due to not medically necessary. I have to wait six months before I can re-submit under my policy. I have since got on the insurance plan of where my husband works at. He has a different plan and a different policy. Well he also has Medical Mutual Ohio Med. I submitted under his policy to get approval for the surgery and they said that I have to wait six months (which is December 30, 2004) before I can re-submit. Can they really use this new claim (new policy) and apply it to my old case? They said that they were allowed to do that being it is the same company. Please let me know what you think.

Medical Mutual denied me. I had to file an appeal with them. Once again I was denied. I contacted the Ohio Department of Insurance (very nice and helpful) and filed a complaint. This results in Ohio Dept of Insurance contacting Medical Mutual and then you have to do a letter to Medical Mutual that you request an external review. Have your doctor do a letter stating that it is medically necessary for you to have the surgery. That is what I did and I had my surgery a week ago today!!! Any other help let me know. Jamie

I'm glad to hear there is a way through med mutual. Thanks, Calvin Selwyn, M.D. Assistant Professor UC Center for Surgical Weight Loss

Hi Michelle, I was just reading over some posts between you & I & I'm sorry to see that you are still fighting with Med Mutual. Have you filed a complaint with the Ohio Department of Insurance??? Please do so if you have not already because it may help your case. I hold a property/Casualty license & I can tell you that, at least on the PC end, complaints filed are taken very seriously. Also, if there is enough fight stirred up, we may some day be able to reverse the option of denials period.... Anyway, don't give up, I never thought that I would get approved & by the grace of God finally won the battle! I will keep you in my thoughts & prayers. Jen

I think they will do or say anything to get out of paying for Medically Necessary Surgery. They don't print these particulars and when you call they provide misleding information. On a good note be happy that December 30 is right around the corner and this time wage an all out war. 1. File you claim 2. If denied, refile 3. denied again contact the State Dept of Insurance. Stay on top of appeal time periods, I filed my appeal requests online the next day I learned of my denial. My claim was overturned by the State Depart of Insurance and I am now scheduled for my consultation. They may have won this battle but I am sure you will win the war