I Need Help!!

I called Medical Mutual of OH today and my denial letter is in the mail. They said I don't have enough documentation of non surgery weight loss attempts. Now, I admit that my records are sketchy. I couldn't get ahold of 3 doctors and the doctors I had barely mentioned what they were asking me to do to loose weight and that I was trying. (Excuse me Med Mutual for not realizing 4 years ago that I was going to need to do this) Sorry, I digress. Anyway, do I have any grounds with which to apeal? Or, am I going to have to spend the the next 6 months going to Weigh****chers, again, and documenting everything and try again then? Or would it be more like a year?

Hey Sharyn, Just wanted you to know you are not alone. I also got my denial letter this week from Medical Mutual. I was going to appeal, but talked to my surgeon's office today and they said "Don't bother trying until you have a 6 month supervised diet with your primary care doc!" What a crock, I have done every diet known to man and even some I have made up. I have lost a lot of weight a lot of times, but it sure always finds me again. Do they actually think we are that bored in life that we just want to have surgery? Anyway, I guess I will start the 6 month weigh ins with the doctor. It sure ticks me off I have to put things on hold just to satisfy the insurance company. Good Luck to you, keep in touch with how your journey comes together. I know you are dissapointed, but try to have a happy holiday!! Hugs, Jane

i am not sure on a lot of things anymore, but i knowthat weigh****chers does not count as a suprivised diet you have to either go to ur doctor or a dietican sorry i cant spell and waitin the 6 months i know seems like a lifetime but it goes by fast and i think savin ur life is more important but best of luck either way

Hi Sharyn. I am in the same boat. I was Recently denied by Aetna for the same reasons. My husband's employer wants TWO YEARS supervised diet (company rules over what Aetna requires!!!) When will this madness stop. I too have been on every diet under the sun, and my PCP did not correctly (according to the insurance) document my attempts at weight loss... Did the Weigh****chers, Jenny Craig... they do not count according to the insurance... and like you said ..."Had I Known..." for me it was had I known over TWO years ago... I with the insurance companies would let OUR DOCTORS make the decisions... THEY don't know us personally and all of our struggles! Isn't it a pity that some have to get into legal battles to save their heath? HUGS ~~Deb

I understand your frustration. I had six visits to my PCP documented but it was over a seven month period ( the dr. had to reschedule one of my appointments ) so my surgeons office said I had to start over again because the visits weren't consecutive. I agree this is madness. I think they try to throw up roadblocks so some people will give up and then the insurance company won't have to pay. If you check into a rehab program for drinking or drugs, no one says you must first have six months documented attempts on your own! Or if you need gall bladder surgery do they first make you go on a dr. supervised low fat diet for six months first ? It's discrimination against the obese!!!!!!! Whew! Thanks for letting me vent. I feel better now. Nancy

Unfortunately Medical Mutual has a lot of hoops. You have to line them up and jump through them all before they will cough up the money to pay for this surgery. Believe me, I know what you're going through. I just spent the last year of my life jumping. I had my surgery 2 1/2 weeks ago. I pray they don't pull anything on me. I have heard they plan to raise the supervised diet attempts to a year so You may want to get to the PCP and start right away. Sorry you have to deal with their crud. Hang in there and fight for your health. It is really worth the fight. I don't know if it will help, but I have the rough draft of the letter I submitted to document my attempts in my profile. Feel free to "borrow" anything in it that might be useful to you. Hugs, Jaimee

I am happy to not be alone, but am saddened by the trouble we are all going through. I don't think any of us woke up and said hey, i wnt a gastrc bypass, just for the hell of it. The sad thing is, i had my consult around July or August. I could have been almost done with the 6 months. I wish the doctors had just told me to go to my PCP and start the process in case I was denied. I guess my insurance company decided that it's cheeper to py $150 a month for my CPAP. Or maybe they figured out that I'm already over my out of pocket max for the year. That's ok, I'll get every test and sleep study my doctors want me take.

Sharyn, see my profile. You should appeal