freakin' insurance companies!!

Laurel W · August 3, 2007

I haven't been on here in a while... funny how life takes control of you sometimes instead of the other way around!!:faint:

But really here's my question- is there anyone out there that has MMO supermed plus and got approved for surgery? i feel that i may be getting the run-around about how my weight i need to lose in my 6 month documented weight loss attempt required for approval. so i guess i was just hoping for some feedback from people that got approved with them and how much weight did you lose in the 6 month thing? thanks a lot!!

Laurel

gmccon · August 3, 2007

My insurance company will pay for 90% of the procedure, once I have satisfied 2 requirements. One, my doctor must put me on a documented, strict diet for six months. Two, I must be at BMI 40, for 3 years. So if I go on the strict diet and lose 50 pounds, for example, how can we document a BMI of 40 for 3 years (I'm at 40 now)? Of course we all know I will put the 50 lbs back on, plus 10. So the hell with it. I'm going to pay 'out-of-pocket' ($15K). If I live even another 5 years, it will pay for itself in other medical costs. Plus, its worth $15K to me to enhance the quality of life. My psych evaluation is next Friday. My personal doctor does the pre-op stuff the week after that, and away we go.

Laurel W · August 4, 2007

thank you for your help gmccon, but do you have medical mutual supermed plus? i think the problem i am having is with my particular insurance... i'm not sure. i understand what you are saying about losing hte wt. then they will say that you dont need the surgery- but my ins is saying that i have to lose "some weight" in the 6 months. august is my 8th month b/c at month 4 i had lost weight, but by month 6 i had gained it back. so i had to do 2 additional months to lose we, and they want me to be "a couple lbs" lower than my starting weight in january. in month 7 i was 1 pound under my starting weight, so i am trying to lose a few more before my appt in aug. but i just want to know if anyone knows exactly how much i have to lose to get approved, no one at the ins co will give me a straight answer. all the say is "some" or "a few pounds". thanks for any info anyone can give.