Re: Mamsi Insurance/WHY OH WHY

[Guest guest]

Dear ,

Why must we beg..........................

Ins does pay for diseases caused by smoking....

Ins does pay for diseases caused by drinking........

Ins does pay for diseases caused by unprotected sex....

Ins does pay for diseases related to drug use.......

Then WHY OH WHY not Morbid Obesity//////////////

Just my 2 cents

Lv Judi in Fla

Quoting lynchk2000@...:

> 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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