Help!!! Does anyone have Medical Mutual?

chameleon · September 9, 2006

I have medical mutual insurance and I have been jumping through hoops of fire for this surgery. At 5'6 and 280 lbs, I am wayyyy above the BMI requirement and the have the required weight history, with sleep apnea, a herniated disk, and written recommendations from two of my docs. They are now requiring a six month clinically documented weight loss attempt within the 12 months prior to approving the surgery! I have given documentation of about 10 years worth of diets, including ww documentation...now they want more stuff. Has anyone had this problem and what can I do other than what I have already started to do which is to see a dietitian (other than myself since I am one!) and follow a "plan" that she has given me, but I have been doing this since last February! I really don't want to wait for another 6 months!! Any Suggestions? When do you get an attorney involved? It seems that they are making the requirements more stringent, the more people they have that are trying to get the surgery!

Sick and Tired of insurance bullshit in OHIO.:angry

ralheit · September 9, 2006

I had medical mutual and also was required to do the 6 month doctor supervised diet thing. After all that, it still took forever for them to even consider me. It got to the end of the year and my company changed insurance. I'm on Anthem now and got approval in 3 weeks. I had to wait 11 months for my surgery because of scxrewing around with medical mutual. I think the only thing you can do is start the diet ASAP, unless you have a doctor that can show your weight history for the last 6 months saying that it was supervised, that would put it in the 12 month window. Best of luck to you.

chabutter · September 10, 2006

HI I was JUST banded, and I DO have medical mutual of ohio. I had no problem getting approved, however I did go through all of the stuff that they asked.

My bmi was just under 40, but I have severe rheumatoid arthritis, and did do six months of weight watchers. once you do it, you should be approved. It takes a month, from time of submisssion to approval