Re: Mamsi Insurance Appeal

[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...

[Guest guest]

,

I think you did a superb job!!! If they don't approve you, I will be really

surprised. Prayers are going out to you.

Elaine

5-24

5 more days

- Mamsi Insurance Appeal

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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