Re: Mamsi Insurance Appeal

[Guest guest]

In a message dated 5/19/2000 12:02:05 AM Eastern Daylight Time,

lynchk2000@... writes:

<< But, I still will not know any final decision for 7 days now. I felt

like I did a good job presenting my case, but wanted to know if

anyone had to go through this type of situation before getting

approved. And if I get denied, then what???? Do I continue to fight?

and how??? Any thoughts?

please advise!

Thanks!

lynchk2000@... >>

,

I cannot be of any help to you as I am waiting insurance approval

myself. I just wanted to say that I'm sorry that they are putting you thru

the wringer like this and how much I admire the fight and desire that you

have to get this far!! Don't lose you're courage, keep fighting, like the old

saying " there's more than one way to skin a cat " If they turn you down, look

for an attorney to check to see if you can sue them for holding back approval

and keeping you from saving you're life!!!!!!!

Wanting

to be on the other side,

Cathy in Lenoir, NC

Patient Info Emailed on 5/2/00

BMI 42

" A Journey Of A Thousand Miles Begins With A Single Step! "

[Guest guest]

Dear ,

I am so proud of you!!!!! It took a lot of courage to stand up to

those people and especially that attorney(the snot!). I don't think you

could have done anything more to present your case. I'll be praying for you

to receive a favorable reply. Hang in there.

God Bless,

Genz

lynchk2000@... wrote:

> Hello,

> My name is and I have posted only one other time, but have to

> share with all of you my insurance story. I have been trying since

> January to get approved for surgury. I have all my information

> ready...but Mamsi (my insurance company) continued to deny my

> requests. So I continued to appeal. Well, after 2 appeals I then had

> to go to before a panel of people and Mamsi representatives to plea

> my case. This happened today. My insurance policy through my work,

> states that they will not cover any weight loss medication or surgery

> for weight reduction purposes. Mamsi told me that this was just the

> group policy my employer had chosen. So, because of that decision I

> could not get this approved...things seemed pretty hopeless. But, I

> was determined to go in front of this group and present my case and

> get an approval. Today at 4pm I went in front of 3 Mamsi employees

> and 3 others who were like community volunteers. (I thought that was

> weird?? how did they get those people?) This panel would of Non Mamsi

> employees would make the final decision. For Mamsi, there was my case

> manager, his assistant and an attorney (a very cocky attorney). The

> panel of people there had all my info in front of them...Dr. R's

> letter, my pcp recommendation letter, my gyno recommendation letter

> and all my appeal letters. I started the meeting with an introduction

> and basically " told my story " and why I thought it should be

> approved. I talked about my ailments, how my health continues to

> worsen and that I continue to gain weight each year..And I felt it

> made more sense and would save so much $ for Mamsi and myself to just

> pay for the surgery as opposed to my visits to dr's for joint pain,

> swelling, high blood pressure, sleep apnea, etc...because my problems

> and healthcare costs are on the rise. I knew they needed to make an

> exception here (according to the policy), so I was asking for an

> exception, their understanding and for them to insure my health. Then

> after I spoke there were a few questions from the panel, and then I

> could ask questions, so I asked if any of Mamsi's policy covered

> weight loss surgery? and the answer was " NO " . So I then said I felt

> like that was discrimination, since the ADA considers Obesity a

> disability! The Mamsi case worker looks at the attorney for

> answers..and the cocky attorney then replies, " Well, this is

> definitely not discriminatio, that is CLEAR. Today almost anything

> can be considered discrimination, but this clearly is not. Miss, (he

> says) you are asking for all of your employees to pay for coverage

> for a surgury or treatment for a situation you have brought on

> yourself! " OMG!! I then said " oh really, so....if I was a

> smoker and got lung cancer, would you cover my radiation and

> treatment for cancer? because afterall, I Chose to smoke???? and

> brought all that on myself...Right? " I then let him know that

> obesity can be partly hereditary, and discrimination did play a

> factor here. He shutup after that and never looked at me in the eyes.

>

> But, I still will not know any final decision for 7 days now. I felt

> like I did a good job presenting my case, but wanted to know if

> anyone had to go through this type of situation before getting

> approved. And if I get denied, then what???? Do I continue to fight?

> and how??? Any thoughts?

>

> please advise!

>

> Thanks!

>

> lynchk2000@...

>

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[Guest guest]

In a message dated 5/18/00 11:02:09 PM Central Daylight Time,

lynchk2000@... writes:

<< Do I continue to fight?

and how??? Any thoughts?

please advise! Dear , You bet, you continue to fight!!!! Those

people make me so mad I could scream. How dare that attorney talk to you

like that!!!! I have gone through the same thing with my ins company. My

surgery finally became an emergency as I could hardly breathe!!! Still they

would and will not pay. I had my surgery in Jan and have lost 72 lbs now and

am feeling great. I have a lawyer now and we are sueing the ins company. I

will keep you posted as we progress. Right now I am waiting for my day in

court with a judge and jury. Then we'll let them decide if the ins company

should pay. My ins is Premiere which is a self owned ins company of the

company where I am retired from and I still have this insurance. WE can not

let these guys get away with this. Many many many people where I am retired

from need this surgery desperately. You hang in there and be determined.

Anne in Missouri

Thanks!

>>

[Guest guest]

!! GO GET 'EM!!! Yeah, it is really discrimination when insurance

companies would pay for my rehab if I was addicted to anything else but

food! I pray they go for your approval!!

fg

At 04:01 AM 05/19/2000 -0000, you wrote:

>Hello,

>My name is and I have posted only one other time, but have to

>share with all of you my insurance story. I have been trying since

>January to get approved for surgury. I have all my information

>ready...but Mamsi (my insurance company) continued to deny my

>requests. So I continued to appeal. Well, after 2 appeals I then had

>to go to before a panel of people and Mamsi representatives to plea

>my case. This happened today. My insurance policy through my work,

>states that they will not cover any weight loss medication or surgery

>for weight reduction purposes. Mamsi told me that this was just the

>group policy my employer had chosen. So, because of that decision I

>could not get this approved...things seemed pretty hopeless. But, I

>was determined to go in front of this group and present my case and

>get an approval. Today at 4pm I went in front of 3 Mamsi employees

>and 3 others who were like community volunteers. (I thought that was

>weird?? how did they get those people?) This panel would of Non Mamsi

>employees would make the final decision. For Mamsi, there was my case

>manager, his assistant and an attorney (a very cocky attorney). The

>panel of people there had all my info in front of them...Dr. R's

>letter, my pcp recommendation letter, my gyno recommendation letter

>and all my appeal letters. I started the meeting with an introduction

>and basically " told my story " and why I thought it should be

>

[Guest guest]

In a message dated 5/19/2000 12:02:04 AM Eastern Daylight Time,

lynchk2000@... writes:

<< I then said " oh really, so....if I was a

smoker and got lung cancer, would you cover my radiation and

treatment for cancer? because afterall, I Chose to smoke???? and

brought all that on myself...Right? " >>

:

Good for you!! You must have felt so satisfied putting that jerk in his

place. I would have been a tongue tied fool if I had to go up in front of

anyone and plead my case. We are proud of you!

Good luck!

Jackie in DE

5 days and counting...