Appeal denied by MMOH...Attorney?

Hi guys, I haven't been here in months, mainly because I was so frustrated with Medical Mutual of Ohio, I couldn't even talk about it. My appeal on their denial of gastic bypass surgery has been denied, too. Does anyone know of a good attorney or law firm that represents patients like me? Also what was the name of the wonderful doctor in Cincinnati area that everyone raved about? I live in the Cleveland area, but if he would accept monthly payments, I'd be willing to drive or fly down there. My dr. at St. Vincents in Cle won't take payments at all. Any help at all would be appreciated. Thanks! Pam

Pam, Does Medical Mutual of Ohio have a clause in their summary of Benefits book that you got from your employer that says anything about "medically necessary"? Do you have any co-morbidities like high blood pressure, sleep apnea, joint pain, ankle swelling, high cholesteral, diabetes, etc? Ohio has an insurance advocate for peons like us. It's called the Ohio Insurance Commission. You can download the forms from the State of Ohio website. Share with them your medical history and why you feel gastric bypass should be a covered expense. I also have the name of a lawyer who had the surgeru himself and now helps others get their second or third appeals through. Try the Ohio Insurance Commission, then go to the website www.obesitylawyers.com Gary J. Viscio telephone 516-742-5300. Good Luck, Luann

Luann, Does the Ohio Insurance Commission have a website?

By federal law there is an Insurance Commission in every state to protect the rights of the people. I found the Ohio Insurance Commission through the State of Ohio website. You might try a google search on it. Luann

Hi Luann, Thanks for your response. Yes, I have severe sleep apnea which was documented by my PCP, with the sleep study results. Medical Mutual of Ohio said I didn't have enough diet history to warrant the surgery, even though my physician, psychiatrist, and surgeon all wote letters on my behalf. I think I was missing one year (2002) of history because I didn't see a dr that year. I just sent an email to Gary Viscio, and asked if he could help me. I'll go to the website you suggested, too, and see what they have there. Thanks again! Pam

i think the name of the doctor in cincinnati that you are speaking of is Trace Curry. He is great. He even checks this message board and posts here, answering questions .

AWESOME!! That's him! I knew it was a "C" name but it's been awhile since I was on this board. Thanks so much. I will look into getting in touch with his office. Pam

Hi Pamela, I have Medical Mutual super Med plus and I kind of had the same problem that you had. Please e-mail me if I can help in anyway. Richard

Thnaks Richard! I will. I need all the support I can get! I'm glad that you were able to overcome your insurance problems and have your surgery! Congratulations on your success! Pam

Hello Pam, I'm in the same boat but different insurance.........UHC. I think I found the website. http://www.ohioinsurance.gov/ConsumServ/ocs/ConsCompl.htm Good luck, Kelly